Provider Demographics
NPI:1336208396
Name:MONTANO, CAROLE L (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:L
Last Name:MONTANO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:CAROLE
Other - Middle Name:A
Other - Last Name:LEVERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:500 VINE STREET
Mailing Address - Street 2:HUMAN RESOURCES
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112
Mailing Address - Country:US
Mailing Address - Phone:860-297-0905
Mailing Address - Fax:860-297-0914
Practice Address - Street 1:500 VINE STREET
Practice Address - Street 2:CAPITOL REGION MENTAL HEALTH CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112
Practice Address - Country:US
Practice Address - Phone:860-297-0905
Practice Address - Fax:860-297-0914
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE38587363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500001640Medicare ID - Type UnspecifiedFIRST COAST
P48845Medicare UPIN