Provider Demographics
NPI:1972219483
Name:MONTANA, DINA BERNADETTE
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:BERNADETTE
Last Name:MONTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W LEAGUE ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-1333
Mailing Address - Country:US
Mailing Address - Phone:567-805-8069
Mailing Address - Fax:
Practice Address - Street 1:22 W LEAGUE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-1333
Practice Address - Country:US
Practice Address - Phone:567-805-8069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH74944666Medicaid