Healthcare Provider Details

I. General information

NPI: 1962828368
Provider Name (Legal Business Name): NICHOLAS FRANK MONTANARO C.R.N.A., M.S.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E. MEDICAL CENTER DR. 1H247 UNIVERSITY HOSPITAL
ANN ARBOR MI
48109-5048
US

IV. Provider business mailing address

3621 S STATE ST 700 KMS PLACE
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-4280
  • Fax:
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRC268385
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704237177
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: