MEDICARE: CARI MICHELLE MONTOYA FNP

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	363LF0000X	Family Nurse Practitioner	AP10807	AZ
2	207Q00000X	Family Medicine Physician	AP10807	AZ

General Provider Information

NPI Number	:	1518471689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARI MICHELLE MONTOYA FNP

Provider Business Mailing Address
First Line	:	21729 N 77TH AVE STE 15
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-2108
Country	:	US
Telephone Number	:	602-315-4103
Fax Number	:	877-293-1631

Provider Business Practice Location Address
First Line	:	21729 N 77TH AVE STE 15
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-2108
Country	:	US
Telephone Number	:	602-315-4103
Fax Number	:	877-293-1631

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

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	11/19/2024

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