Provider Demographics
NPI:1083763627
Name:MONTANARO, KATHERINE L (CNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:MONTANARO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0378
Mailing Address - Country:US
Mailing Address - Phone:888-531-7444
Mailing Address - Fax:614-867-9889
Practice Address - Street 1:590 NEWARK GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1436
Practice Address - Country:US
Practice Address - Phone:888-531-7444
Practice Address - Fax:614-867-9889
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09065363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2727580Medicaid
OHMONP80341Medicare PIN