Provider Demographics
NPI:1265818561
Name:MONTELLANO, MIRANDA T (DNP, ARNP, CNM)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:T
Last Name:MONTELLANO
Suffix:
Gender:F
Credentials:DNP, ARNP, CNM
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:T
Other - Last Name:HASTINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, ARNP, CNM
Mailing Address - Street 1:902 7TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-4104
Mailing Address - Country:US
Mailing Address - Phone:360-298-8044
Mailing Address - Fax:216-930-5958
Practice Address - Street 1:902 7TH ST STE 101
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-4104
Practice Address - Country:US
Practice Address - Phone:360-298-8044
Practice Address - Fax:216-930-5958
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60588624363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology