Provider Demographics
NPI:1457005092
Name:MONTOYA, CASSANDRA A (RN)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:A
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E BRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5748
Mailing Address - Country:US
Mailing Address - Phone:480-845-2203
Mailing Address - Fax:
Practice Address - Street 1:3625 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3198
Practice Address - Country:US
Practice Address - Phone:623-915-8005
Practice Address - Fax:623-915-8102
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN205624163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool