Provider Demographics
NPI:1679553457
Name:MONTANO, F. ELAINE (CFNP)
Entity type:Individual
Prefix:MRS
First Name:F.
Middle Name:ELAINE
Last Name:MONTANO
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:PROF
Other - First Name:F.
Other - Middle Name:ELAINE
Other - Last Name:MONTANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNP
Mailing Address - Street 1:130 SIRINGO RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5747
Mailing Address - Country:US
Mailing Address - Phone:505-989-3236
Mailing Address - Fax:505-989-5079
Practice Address - Street 1:130 SIRINGO RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5747
Practice Address - Country:US
Practice Address - Phone:505-989-3236
Practice Address - Fax:505-989-5079
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR27286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ05604Medicare UPIN