Provider Demographics
NPI:1437571643
Name:MONTGOMERY, PIYANUD A
Entity Type:Individual
Prefix:MRS
First Name:PIYANUD
Middle Name:A
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 1:957 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-2639
Mailing Address - Country:US
Mailing Address - Phone:651-261-1193
Mailing Address - Fax:651-331-5077
Practice Address - Street 1:689 DALE ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1644
Practice Address - Country:US
Practice Address - Phone:651-261-1193
Practice Address - Fax:651-331-5077
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker