Provider Demographics
NPI:1679735641
Name:MONTOYA, ANNETTE M (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-7610
Mailing Address - Fax:303-415-7618
Practice Address - Street 1:4747 ARAPAHOE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1133
Practice Address - Country:US
Practice Address - Phone:303-415-7610
Practice Address - Fax:303-415-7618
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0005741-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83075721Medicaid
CO83075721Medicaid