MEDICARE: MS. ROSA ISELA MONTENEGRO CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	AP137426	TX

General Provider Information

NPI Number	:	1093205932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSA ISELA MONTENEGRO CPNP

Provider Business Mailing Address
First Line	:	4500 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6102
Country	:	US
Telephone Number	:	915-532-9000
Fax Number	:	915-532-9006

Provider Business Practice Location Address
First Line	:	4500 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6102
Country	:	US
Telephone Number	:	915-532-9000
Fax Number	:	915-532-9006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2018
Last Update Date	:	05/16/2018

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