Provider Demographics
NPI:1407194111
Name:MONTERO PEREZ, EDWIN (BSN, RN)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:MONTERO PEREZ
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:MR
Other - First Name:EDWIN
Other - Middle Name:
Other - Last Name:MONTERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:1006 EWING AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4010
Mailing Address - Country:US
Mailing Address - Phone:727-286-6943
Mailing Address - Fax:
Practice Address - Street 1:1006 EWING AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4010
Practice Address - Country:US
Practice Address - Phone:727-286-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9291366163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse