1265818561 NPI number — MIRANDA T MONTELLANO DNP, ARNP, CNM

Table of content: MIRANDA T MONTELLANO DNP, ARNP, CNM (NPI 1265818561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265818561 NPI number — MIRANDA T MONTELLANO DNP, ARNP, CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTELLANO
Provider First Name:
MIRANDA
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP, ARNP, CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HASTINGS
Provider Other First Name:
MIRANDA
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DNP, ARNP, CNM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265818561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
902 7TH ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANACORTES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98221-4104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-298-8044
Provider Business Mailing Address Fax Number:
216-930-5958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 7TH ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANACORTES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98221-4104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-298-8044
Provider Business Practice Location Address Fax Number:
216-930-5958
Provider Enumeration Date:
08/10/2015

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: 363LX0001X , with the licence number:  AP60588624 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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