Provider Demographics
NPI:1346895778
Name:MONTENEGRO, MARY MAY (FNP- BC)
Entity type:Individual
Prefix:
First Name:MARY MAY
Middle Name:
Last Name:MONTENEGRO
Suffix:
Gender:F
Credentials:FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 BRADSHAW DR
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2361
Mailing Address - Country:US
Mailing Address - Phone:732-552-6845
Mailing Address - Fax:
Practice Address - Street 1:83 BRADSHAW DR
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2361
Practice Address - Country:US
Practice Address - Phone:732-552-6845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00942400363LF0000X, 363LP0808X
NY349159363LF0000X
NY405740363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily