Basic Information
| Provider Information | |||||||||
| NPI: | 1689945271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOUNGA | ||||||||
| FirstName: | VA | ||||||||
| MiddleName: | SHARON | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1056 W 2300 N | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846041228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019950682 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 W UNIVERSITY PKWY | ||||||||
| Address2: | STUDENT HEALTH SERVICES SC 221 | ||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840586703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018638876 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2012 | ||||||||
| LastUpdateDate: | 01/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 6470833-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 6470833-8900 | UT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.