Provider Demographics
NPI:1790474799
Name:MONTANTEZ, NORMALINDA AYALA
Entity Type:Individual
Prefix:
First Name:NORMALINDA
Middle Name:AYALA
Last Name:MONTANTEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 MENDENHALL AVE
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520-1653
Mailing Address - Country:US
Mailing Address - Phone:682-340-1172
Mailing Address - Fax:
Practice Address - Street 1:1015 MENDENHALL AVE
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1653
Practice Address - Country:US
Practice Address - Phone:682-340-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251E00000XAgenciesHome Health
No376K00000XNursing Service Related ProvidersNurse's Aide