Provider Demographics
NPI:1285681429
Name:MONTOUTE, SIMONE L (CNM)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:L
Last Name:MONTOUTE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SIMONE
Other - Middle Name:
Other - Last Name:MONTOUTE-MEDFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1150 VARNUM ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2104
Mailing Address - Country:US
Mailing Address - Phone:202-854-7075
Mailing Address - Fax:202-854-7470
Practice Address - Street 1:1150 VARNUM STREET. NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2104
Practice Address - Country:US
Practice Address - Phone:202-854-7075
Practice Address - Fax:202-854-7470
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3018062367A00000X
DCRN1038693176B00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340335100Medicaid
FLP37501Medicare UPIN
FL340335100Medicaid