Provider Demographics
NPI:1740245042
Name:MONTAGNA, RONICA (CRNP)
Entity Type:Individual
Prefix:
First Name:RONICA
Middle Name:
Last Name:MONTAGNA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S FORGE RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-9519
Mailing Address - Country:US
Mailing Address - Phone:717-838-1301
Mailing Address - Fax:
Practice Address - Street 1:1400 S FORGE RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-9519
Practice Address - Country:US
Practice Address - Phone:717-838-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005881B363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATP005881BOtherSTATE LICENSE - CRNP
11267051OtherCAQH
11267051OtherCAQH