Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | CNP00778 | NM |
NPI | 1093829244 |
---|---|
Provider Name | Cindy A Montgomery |
First Address | Las Cruces, NM 88011-8255 |
Second Address | Las Cruces, NM 88011-8255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000T4781 | (05) | NM |