Provider Demographics
NPI:1033635321
Name:MONTGOMERY, SONJA GAY (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:GAY
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 96TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73026-5964
Mailing Address - Country:US
Mailing Address - Phone:405-496-3905
Mailing Address - Fax:
Practice Address - Street 1:900 E. MAIN STREET BUILDING 200
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73070
Practice Address - Country:US
Practice Address - Phone:405-307-4897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK94973163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$Medicaid