Provider Demographics
NPI:1528114428
Name:MONTESANO, MARY FRANCES (RN PNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:FRANCES
Last Name:MONTESANO
Suffix:
Gender:F
Credentials:RN PNP
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:MONTESANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN PNP
Mailing Address - Street 1:7530 NW MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9106
Mailing Address - Country:US
Mailing Address - Phone:541-745-2534
Mailing Address - Fax:
Practice Address - Street 1:1075 SW CEDARWOOD AVE
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6818
Practice Address - Country:US
Practice Address - Phone:503-435-1435
Practice Address - Fax:503-435-1435
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000035633N2 PNP-PP363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics