Healthcare Provider Details

I. General information

NPI: 1174815377
Provider Name (Legal Business Name): DIANNE CAROL MONTENERO APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE DEPARTMENT OF OTOLARYNGOLOGY
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE DEPARTMENT OF OTOLARYNGOLOGY
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-5580
  • Fax: 414-955-6440
Mailing address:
  • Phone: 414-805-5580
  • Fax: 414-955-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4182
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: