Basic Information
| Provider Information | |||||||||
| NPI: | 1093142697 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTES | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | MELISSA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 28953 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937298953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592997700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 729 N MEDICAL CTR DR WEST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592997700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2013 | ||||||||
| LastUpdateDate: | 09/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 16036 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.