Provider Demographics
NPI:1275978579
Name:MONTENEGRO, RAY (FNP)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:MONTENEGRO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6655 W SAHARA AVE
Mailing Address - Street 2:SUITE D-110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0842
Mailing Address - Country:US
Mailing Address - Phone:972-996-0900
Mailing Address - Fax:972-996-0905
Practice Address - Street 1:6655 W SAHARA AVE
Practice Address - Street 2:SUITE D-110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0842
Practice Address - Country:US
Practice Address - Phone:972-996-0900
Practice Address - Fax:972-996-0905
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVF1212409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily