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NPI Code Detail

MEDICARE: ISMARI MONTANEZ

MEDICARE: ISMARI MONTANEZ
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
1163W00000XRegistered NurseRN0000147736TN
2363L00000XNurse Practitioner22663TN

Other Identifiers

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

General Provider Information

NPI Number : 1306965926
Entity Type Code : Individual
Provider Name (Legal Business Name) : ISMARI MONTANEZ
Provider Business Mailing Address
First Line : PO BOX 2072
Second Line :
City : COLLEGEDALE
State : TN
Zip : 37315-2072
Country : US
Telephone Number : 423-227-8955
Fax Number :
Provider Business Practice Location Address
First Line : 362 CALLEN LN NW
Second Line : SUITE 110
City : CLEVELAND
State : TN
Zip : 37312-3784
Country : US
Telephone Number : 423-331-5025
Fax Number : 423-698-0511
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 08/29/2022

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Directions to “ ISMARI MONTANEZ ” Practice Location

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