Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A142034 | CA |
NPI | 1043508872 |
---|---|
Provider Name | Glenda Lois Montague |
First Address | Napa, CA 94558-2909 |
Second Address | Napa, CA 94558-2909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2011 |
Last Update Date | 08/11/2021 |