MEDICARE: MS. CAROLYN MONTOYA PNP

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	363LP0200X	Pediatric Nurse Practitioner	R15539	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134127079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN MONTOYA PNP

Provider Business Mailing Address
First Line	:	4702 CONSTITUTION AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-5804
Country	:	US
Telephone Number	:	505-255-1896
Fax Number	:

Provider Business Practice Location Address
First Line	:	COLLEGE OF NURSING MSC O9 5350
Second Line	:	1 UNIVERSITY OF NEW MEXICO
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-0001
Country	:	US
Telephone Number	:	505-272-8875
Fax Number	:

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	11/06/2011

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