Provider Demographics
NPI:1265067326
Name:MONTOYA, ERVY MARIE (SA)
Entity type:Individual
Prefix:DR
First Name:ERVY MARIE
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:SA
Other - Prefix:DR
Other - First Name:ERVY MARIE
Other - Middle Name:
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SURGERY ASSISTANT
Mailing Address - Street 1:7157 W HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7157 W HOWARD ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3757
Practice Address - Country:US
Practice Address - Phone:847-696-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical