Doctor Name: | MICHELLE MONTGOMERY |
NPI Number: | 1043290323 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | WHNP |
License Number: | 2002007463 |
Business Practice Address: | 559 Vincent St Family Practice Clinic Peterson Afb, CO - 809141540 |
Business Phone Number: | 7195561080 |
Business Fax Number: | 7195561266 |
Mailing Address: | 559 Vincent St, Family Practice Clinic COLORADO SPRINGS |
State: | CO |
Postal Code: | 809141541 |
Phone Number: | 7195561080 |
Fax Number: | 7195561266 |
NPI Enumeration Date: | 01/20/2006 |
NPI Last Update Date: | 04/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | 2002007463 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |