Provider Demographics
NPI:1790026029
Name:MONTOYA, MONICA CECILIA (LPN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:CECILIA
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5932
Mailing Address - Country:US
Mailing Address - Phone:614-934-5596
Mailing Address - Fax:
Practice Address - Street 1:451 VISTA DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5932
Practice Address - Country:US
Practice Address - Phone:614-934-5596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN136868164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse