| Doctor Name: | MRS. IDA SUE MONTGOMERY |
| NPI Number: | 1104809359 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | APRN-384 |
| Business Practice Address: | 301 Andrews Avenue Lyster Army Outpatient Clinic Fort Rucker, AL - 36362 |
| Business Phone Number: | 3342557387 |
| Business Fax Number: | |
| Mailing Address: | 301 Andrews Avenue, Lyster Army Outpatient Clinic FORT RUCKER |
| State: | AL |
| Postal Code: | 36362 |
| Phone Number: | 3342557387 |
| Fax Number: | |
| NPI Enumeration Date: | 11/22/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | APRN-384 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |