Individual
MRS. ANTONETTE MONTALVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP - PC
Contact information
Practice address
4417 N 6TH ST, PHILADELPHIA, PA 19140-2319
(215) 302-3600
Mailing address
4417 N 6TH ST, PHILADELPHIA, PA 19140-2319
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
SP013412
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029044300001
—
PA
Enumeration date
11/20/2013
Last updated
08/27/2015
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