Provider Demographics
NPI:1689918047
Name:MONTAG, ARINA ILSE JOHANNA (ASSOCIATE DEGREE RN)
Entity Type:Individual
Prefix:
First Name:ARINA
Middle Name:ILSE JOHANNA
Last Name:MONTAG
Suffix:
Gender:F
Credentials:ASSOCIATE DEGREE RN
Other - Prefix:
Other - First Name:ARINA
Other - Middle Name:ILSE JOHANNA
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASSAOCIATE DEGREE RN
Mailing Address - Street 1:27 11TH AVE
Mailing Address - Street 2:#RD FLOOR
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-3240
Mailing Address - Country:US
Mailing Address - Phone:978-876-4915
Mailing Address - Fax:
Practice Address - Street 1:27 11TH AVE
Practice Address - Street 2:#RD FLOOR
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-3240
Practice Address - Country:US
Practice Address - Phone:978-876-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-24
Last Update Date:2012-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN177378163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse