Provider Demographics
NPI:1790544864
Name:MONTEMAYOR, ROSE ABIGAEL (RN)
Entity Type:Individual
Prefix:
First Name:ROSE ABIGAEL
Middle Name:
Last Name:MONTEMAYOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MILLSTADT
Mailing Address - State:IL
Mailing Address - Zip Code:62260-1625
Mailing Address - Country:US
Mailing Address - Phone:217-801-7205
Mailing Address - Fax:
Practice Address - Street 1:4210 GREEN TREE DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1941
Practice Address - Country:US
Practice Address - Phone:217-801-7205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95335837163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse