Provider Demographics
NPI:1396986212
Name:MONTILLA RODRIGUEZ, CLARIBEL MARIA (FNP-BC)
Entity type:Individual
Prefix:
First Name:CLARIBEL
Middle Name:MARIA
Last Name:MONTILLA RODRIGUEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5414 ROTARY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6117
Mailing Address - Country:US
Mailing Address - Phone:301-865-0019
Mailing Address - Fax:
Practice Address - Street 1:5414 ROTARY AVE
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6117
Practice Address - Country:US
Practice Address - Phone:301-865-0019
Practice Address - Fax:301-865-0020
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR113839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD012298M92Medicare UPIN