Provider Demographics
NPI:1528257391
Name:MONTES, RITA M (NP)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:M
Last Name:MONTES
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Gender:F
Credentials:NP
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Mailing Address - Street 1:20 HOPE AVE
Mailing Address - Street 2:STE G 01
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2721
Mailing Address - Country:US
Mailing Address - Phone:781-788-0005
Mailing Address - Fax:781-788-0006
Practice Address - Street 1:20 HOPE AVE
Practice Address - Street 2:STE G 01
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2721
Practice Address - Country:US
Practice Address - Phone:781-788-0005
Practice Address - Fax:781-788-0006
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2011-04-06
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Provider Licenses
StateLicense IDTaxonomies
MA274989363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0716146Medicaid
MA0716146Medicaid