Provider Demographics
NPI:1407973878
Name:MONTGOMERY, LAUREL I (NP MSN)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:I
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:NP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 POTRERO AVE FL BLDG.9-2ND
Mailing Address - Street 2:SFGH - OCCUPATIONAL HEALTH SERVICE
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-6581
Mailing Address - Fax:415-206-3669
Practice Address - Street 1:1001 POTRERO AVE FL BLDG.9-2ND
Practice Address - Street 2:SFGH - OCCUPATIONAL HEALTH SERVICE
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-6581
Practice Address - Fax:415-206-3669
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN476780163WX0106X
CANPF8976363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
Not Answered363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
069245OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
069245OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER