Healthcare Provider Details

I. General information

NPI: 1396649455
Provider Name (Legal Business Name): MURIELLE MONTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 FAIRBANKS RD
BROCKTON MA
02302-4508
US

IV. Provider business mailing address

34 FAIRBANKS RD
BROCKTON MA
02302-4508
US

V. Phone/Fax

Practice location:
  • Phone: 617-840-1486
  • Fax:
Mailing address:
  • Phone: 617-840-1486
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2341107
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2341107
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN2341107
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: