Healthcare Provider Details

I. General information

NPI: 1124281340
Provider Name (Legal Business Name): VALERIE ROSE MONTERREY CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 LONGACRE AVE
ERIE PA
16509-1552
US

IV. Provider business mailing address

208 LONGACRE AVE
ERIE PA
16509-1552
US

V. Phone/Fax

Practice location:
  • Phone: 814-392-2277
  • Fax: 814-864-5183
Mailing address:
  • Phone: 814-392-2277
  • Fax: 814-864-5183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number06030015
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129000072
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: