Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | O0945 | ID |
NPI | 1326280769 |
---|---|
Provider Name | Shari Vandyke Montandon |
First Address | Louisville, KY 40202-1622 |
Second Address | Coeur D Alene, ID 83814-9330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2009 |
Last Update Date | 28/12/2017 |