Provider Demographics
NPI:1649674508
Name:MONTZ, COLLEEN ANNE (FNP)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ANNE
Last Name:MONTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E. ALOSTA AVE.
Mailing Address - Street 2:STUDENT HEALTH CENTER
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702
Mailing Address - Country:US
Mailing Address - Phone:626-815-2100
Mailing Address - Fax:626-815-2102
Practice Address - Street 1:901 E. ALOSTA AVE.
Practice Address - Street 2:STUDENT HEALTH CENTER
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702
Practice Address - Country:US
Practice Address - Phone:626-815-2100
Practice Address - Fax:626-815-2102
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95001390363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care