Provider Demographics
NPI:1386508455
Name:MONTEJO MAGANA, ORDELIS (APRN-CNP)
Entity type:Individual
Prefix:
First Name:ORDELIS
Middle Name:
Last Name:MONTEJO MAGANA
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5803 SHADY HILL LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2124
Mailing Address - Country:US
Mailing Address - Phone:682-213-0816
Mailing Address - Fax:
Practice Address - Street 1:5803 SHADY HILL LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2124
Practice Address - Country:US
Practice Address - Phone:682-213-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-12
Last Update Date:2025-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045294163W00000X, 163WA2000X, 163WH0200X, 163WI0500X
TXAPRN11040684364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy