Provider Demographics
NPI:1417275215
Name:MONTANA, BROOKLYN DEBORAH (CNA)
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:DEBORAH
Last Name:MONTANA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4844 COUNTY ROAD 43
Mailing Address - Street 2:UNIT 3
Mailing Address - City:BAILEY
Mailing Address - State:CO
Mailing Address - Zip Code:80421-1134
Mailing Address - Country:US
Mailing Address - Phone:303-838-2522
Mailing Address - Fax:303-816-1257
Practice Address - Street 1:700 COLORADO BLVD
Practice Address - Street 2:SUITE 318
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4084
Practice Address - Country:US
Practice Address - Phone:866-801-9492
Practice Address - Fax:866-293-4719
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO159181376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide