Provider Demographics
NPI:1467778365
Name:MONTANEZ, CYNTHIA M (RN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:M
Last Name:MONTANEZ
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 1:12000 STONE LAKE ROAD
Mailing Address - Street 2:JICARILLA SERVICE UNIT
Mailing Address - City:DULCE
Mailing Address - State:NM
Mailing Address - Zip Code:87528
Mailing Address - Country:US
Mailing Address - Phone:575-759-3291
Mailing Address - Fax:575-759-7294
Practice Address - Street 1:12000 STONE LAKE ROAD
Practice Address - Street 2:JICARILLA SERVICE UNIT
Practice Address - City:DULCE
Practice Address - State:NM
Practice Address - Zip Code:87528
Practice Address - Country:US
Practice Address - Phone:575-759-3291
Practice Address - Fax:575-759-7294
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ147647163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse