Provider Demographics
NPI:1144931759
Name:MONTECILLO, ELIZABETH VELASCO (BSN, RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:VELASCO
Last Name:MONTECILLO
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:VELASCO
Other - Last Name:SAN JUAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:894 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1115
Mailing Address - Country:US
Mailing Address - Phone:609-488-9223
Mailing Address - Fax:
Practice Address - Street 1:894 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1115
Practice Address - Country:US
Practice Address - Phone:609-488-9223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR11749100163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse