Provider Demographics
NPI:1134954563
Name:MONTOYA, STACEY MICHELLE (RN)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:MICHELLE
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:MICHELLE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2360 EAST PERSHING BLVD
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001
Mailing Address - Country:US
Mailing Address - Phone:307-778-7550
Mailing Address - Fax:
Practice Address - Street 1:2360 EAST PERSHING BLVD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:307-778-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY26808163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency