Provider Demographics
NPI:1295220432
Name:MONTGOMERY, LATONYA DIANNE
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:DIANNE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 REGENT RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1916
Mailing Address - Country:US
Mailing Address - Phone:216-526-1577
Mailing Address - Fax:
Practice Address - Street 1:3439 REGENT RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1916
Practice Address - Country:US
Practice Address - Phone:216-526-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0235407Medicaid