Provider Demographics
NPI:1154494904
Name:MONTGOMERY, LADONNA M (NON-AID)
Entity Type:Individual
Prefix:MRS
First Name:LADONNA
Middle Name:M
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:NON-AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5439 GRASSYFORK RD
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-8911
Mailing Address - Country:US
Mailing Address - Phone:740-493-3734
Mailing Address - Fax:
Practice Address - Street 1:5439 GRASSYFORK RD
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-8911
Practice Address - Country:US
Practice Address - Phone:740-493-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2584967Medicaid