Healthcare Provider Details

I. General information

NPI: 1184233728
Provider Name (Legal Business Name): MARCIA MONTANEZ CATHEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 S DELSEA DR
VINELAND NJ
08360-7449
US

IV. Provider business mailing address

4 W JUDITH DR
HAMMONTON NJ
08037-9614
US

V. Phone/Fax

Practice location:
  • Phone: 856-293-6974
  • Fax:
Mailing address:
  • Phone: 856-986-9374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ01005700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ01005700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: