Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN-2383 | HI |
NPI | 1003305434 |
---|---|
Provider Name | Angela Montgomery |
First Address | Honolulu, HI 96813-5408 |
Second Address | Honolulu, HI 96817-4295 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2018 |
Last Update Date | 29/01/2019 |