Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP132415 | TX |
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP132415 | TX |
NPI | 1003359548 |
---|---|
Provider Name | Crystal Marlen Montes |
First Address | San Antonio, TX 78291-0276 |
Second Address | San Antonio, TX 78229-3342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2016 |
Last Update Date | 14/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
369386301 | (05) | TX |