Provider Demographics
NPI:1407120710
Name:MONTGOMERY, RITA ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:ANN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 US ROUTE 20
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-8450
Mailing Address - Country:US
Mailing Address - Phone:315-406-1010
Mailing Address - Fax:
Practice Address - Street 1:22 MYNDERSE ST
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-1407
Practice Address - Country:US
Practice Address - Phone:315-406-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232882164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse