1396772158 NPI number — MS. GWENDOLYN EVON MONTES A.R.N.P.

Table of content: MS. GWENDOLYN EVON MONTES A.R.N.P. (NPI 1396772158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396772158 NPI number — MS. GWENDOLYN EVON MONTES A.R.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTES
Provider First Name:
GWENDOLYN
Provider Middle Name:
EVON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
A.R.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONTES
Provider Other First Name:
GWENDOLYN
Provider Other Middle Name:
DAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
A.R.N.P.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1396772158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 N ASTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROKEN ARROW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74012-9136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-951-3259
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
334 E APACHE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74106-3704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-585-1550
Provider Business Practice Location Address Fax Number:
918-728-8686
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  R0047676 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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