Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 3566 | NM |
NPI | 1912970070 |
---|---|
Provider Name | Jeanette Monteleone |
First Address | Trinidad, CO 81082-3013 |
Second Address | Trinidad, CO 81082-3013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 16/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
350031479 | (02) | CO |
U37421 | (02) |