Provider Demographics
NPI:1477096956
Name:MONTEIRO, KRISTEN (RN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MONTEIRO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:BUCALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44 RICHMOND BLVD UNIT 2A
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3621
Mailing Address - Country:US
Mailing Address - Phone:631-561-7484
Mailing Address - Fax:
Practice Address - Street 1:240 MASTIC BEACH RD
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-1028
Practice Address - Country:US
Practice Address - Phone:631-874-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY654121163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool