Basic Information
Provider Information
NPI: 1558796391
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MONSON
FirstName: DEAN
MiddleName: KIRK
NamePrefix: MR.
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 474 W 200 N
Address2: SUITE #300
City: ST GEORGE
State: UT
PostalCode: 847704505
CountryCode: US
TelephoneNumber: 4356345600
FaxNumber: 4359868700
Practice Location
Address1: 474 W 200 N
Address2:  
City: ST GEORGE
State: UT
PostalCode: 847704505
CountryCode: US
TelephoneNumber: 4356345600
FaxNumber: 4359868700
Other Information
ProviderEnumerationDate: 09/11/2013
LastUpdateDate: 01/14/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X5531793-4405UTY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000X5531793-8900UTN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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