Provider Demographics
NPI:1831649755
Name:MONTEON, MARISSA T (LVN, RN, BSN)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:T
Last Name:MONTEON
Suffix:
Gender:F
Credentials:LVN, RN, BSN
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:TORRES
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1033 HOBSON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-2132
Mailing Address - Country:US
Mailing Address - Phone:530-661-2750
Mailing Address - Fax:
Practice Address - Street 1:1033 HOBSON AVE
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-2132
Practice Address - Country:US
Practice Address - Phone:916-402-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290945164X00000X
CA95224302163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse