Provider Demographics
NPI:1487830436
Name:MONTALVO, GABRIELLE L (CRNP)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:L
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 HUNTINGDON PIKE STE 357
Mailing Address - Street 2:
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8009
Mailing Address - Country:US
Mailing Address - Phone:215-938-1999
Mailing Address - Fax:215-938-1203
Practice Address - Street 1:1650 HUNTINGDON PIKE STE 357
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8009
Practice Address - Country:US
Practice Address - Phone:215-938-1999
Practice Address - Fax:215-938-1203
Is Sole Proprietor?:No
Enumeration Date:2008-01-20
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008491363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health