Provider Demographics
NPI:1003647256
Name:MONTALVO, SHANEL (RN)
Entity type:Individual
Prefix:MS
First Name:SHANEL
Middle Name:
Last Name:MONTALVO
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 1:911 LOCUST ST APT 606
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63101-1447
Mailing Address - Country:US
Mailing Address - Phone:585-397-6620
Mailing Address - Fax:
Practice Address - Street 1:2248 WELSCH INDUSTRIAL CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4222
Practice Address - Country:US
Practice Address - Phone:314-356-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024025089163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse