MEDICARE: MARGIE MONTOYA RN, CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	R26268	NM

General Provider Information

NPI Number	:	1093842932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGIE MONTOYA RN, CNP

Provider Business Mailing Address
First Line	:	3069 PLAZA BLANCA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-5341
Country	:	US
Telephone Number	:	505-476-8875
Fax Number	:	505-476-8898

Provider Business Practice Location Address
First Line	:	605 LETRADO ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4146
Country	:	US
Telephone Number	:	505-476-2600
Fax Number	:	505-476-2692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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