Provider Demographics
NPI:1033707443
Name:MONTGOMERY, LAINE HURLEY (CD(DONA))
Entity Type:Individual
Prefix:
First Name:LAINE
Middle Name:HURLEY
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 REAGAN TER
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2638
Mailing Address - Country:US
Mailing Address - Phone:512-769-9913
Mailing Address - Fax:
Practice Address - Street 1:1201 REAGAN TER
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2638
Practice Address - Country:US
Practice Address - Phone:512-769-9913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374J00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula