Healthcare Provider Details

I. General information

NPI: 1487830436
Provider Name (Legal Business Name): GABRIELLE L MONTALVO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2008
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 HUNTINGDON PIKE STE 357
MEADOWBROOK PA
19046-8009
US

IV. Provider business mailing address

1650 HUNTINGDON PIKE STE 357
MEADOWBROOK PA
19046-8009
US

V. Phone/Fax

Practice location:
  • Phone: 215-938-1999
  • Fax: 215-938-1203
Mailing address:
  • Phone: 215-938-1999
  • Fax: 215-938-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP008491
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: