Provider Demographics
NPI:1346831203
Name:MM NURSE PRACTITIONER IN FAMILY HEALTH MOBILE CARE
Entity Type:Organization
Organization Name:MM NURSE PRACTITIONER IN FAMILY HEALTH MOBILE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONTOPOLI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:607-438-6727
Mailing Address - Street 1:148 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-9785
Mailing Address - Country:US
Mailing Address - Phone:607-438-6727
Mailing Address - Fax:
Practice Address - Street 1:9390 WIXSON ROAD
Practice Address - Street 2:
Practice Address - City:HAMMONDSPORT
Practice Address - State:NY
Practice Address - Zip Code:14840
Practice Address - Country:US
Practice Address - Phone:607-438-6727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty