Provider Demographics
NPI:1720196694
Name:MONTELARO, CORRINE CATHERINE (CRNA)
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:CATHERINE
Last Name:MONTELARO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CORRINE
Other - Middle Name:MONTELARO
Other - Last Name:BECHTOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:713-620-4000
Mailing Address - Fax:
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:STE 301
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-0319
Practice Address - Country:US
Practice Address - Phone:225-214-6436
Practice Address - Fax:225-214-6437
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05655367500000X
SC074701367500000X
TXAP117000367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00718347OtherRAILROAD MEDICARE
TX89635UOtherBLUE CROSS BLUE SHIELD
SCAN1463Medicaid
TX200920101Medicaid
TX200920101Medicaid
Q68304Medicare UPIN
SCAN1463Medicaid