1942128160 NPI number — MARISA MARIA MONTELEONE FNP-BC

Table of content: MARISA MARIA MONTELEONE FNP-BC (NPI 1942128160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942128160 NPI number — MARISA MARIA MONTELEONE FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTELEONE
Provider First Name:
MARISA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942128160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28004 ROY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLAIR SHORES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48081-2945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-850-1445
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4050 W MAPLE RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48301-3118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-885-8211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2026

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: 363LF0000X , with the licence number:  4704363273 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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