Provider Demographics
NPI:1033825740
Name:MONTGOMERY, MONIQUE RENEE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:RENEE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 DOVERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-4210
Mailing Address - Country:US
Mailing Address - Phone:713-261-6700
Mailing Address - Fax:
Practice Address - Street 1:2335 DOVERGLEN DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-4210
Practice Address - Country:US
Practice Address - Phone:713-261-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX851203163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty