Healthcare Provider Details

I. General information

NPI: 1548965262
Provider Name (Legal Business Name): WILMARIE MONTERO-NEGRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ROBINSON ST
POTTSTOWN PA
19464-6421
US

IV. Provider business mailing address

11 ROBINSON ST
POTTSTOWN PA
19464-6421
US

V. Phone/Fax

Practice location:
  • Phone: 484-941-0500
  • Fax:
Mailing address:
  • Phone: 484-941-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP027590
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN663776
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: