Individual
JENNELEA R MONTANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
13616 CALIFORNIA ST, STE 100, OMAHA, NE 68154-5335
(402) 496-0404
(402) 496-0517
Mailing address
13616 CALIFORNIA ST, STE 100, OMAHA, NE 68154-5335
(402) 496-0404
(402) 496-0517
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1192
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1192
NE LICENSE
NE
Enumeration date
10/02/2006
Last updated
03/15/2016
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