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Organization

MONOVO LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. TYSON WADE LEWIS RN (DIRECTOR OF CLINICAL OPERATIONS)
(801) 380-4462
Entity
Organization

Contact information

Practice address
2578 W 600 N STE 201, LINDON, UT 84042-1260
(801) 896-9868
(801) 823-6337
Mailing address
2578 W 600 N STE 201, LINDON, UT 84042-1260
(801) 896-9868

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
207Q00000X
Family Medicine Physician
Primary
261QH0100X
Health Service Clinic/Center
261QP2300X
Primary Care Clinic/Center
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner
363LF0000X
Family Nurse Practitioner
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
363LP2300X
Primary Care Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1205288628
UT
05
1275576274
UT
05
1396493086
UT
05
1407407679
UT
05
1578118659
UT
Enumeration date
02/08/2023
Last updated
02/26/2025
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