Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 2002007463 | MO |
NPI | 1043290323 |
---|---|
Provider Name | Michelle Montgomery |
First Address | Colorado Springs, CO 80914-1541 |
Second Address | Peterson Afb, CO 80914-1540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 13/04/2010 |