Individual
TANIAISHAEL MONTANEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5000 W NATIONAL AVE, MILWAUKEE, WI 53295-0001
(414) 514-0772
Mailing address
1331 W BROWN ST, MILWAUKEE, WI 53205-1223
(414) 514-0772
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
318747
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
318747
LPN LICENSE
WI
Enumeration date
08/07/2018
Last updated
08/07/2018
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