Provider Demographics
NPI:1710564166
Name:MONTERO, JOSHUA (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:MONTERO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 WESTFIELD ST APT B3
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2553
Mailing Address - Country:US
Mailing Address - Phone:413-505-0195
Mailing Address - Fax:
Practice Address - Street 1:469 WESTFIELD ST APT B3
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2553
Practice Address - Country:US
Practice Address - Phone:413-505-0195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN96376164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS74602581OtherDRIVERS LICENSE