Provider Demographics
NPI:1437718749
Name:MONTGOMERY, ALISSE (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:ALISSE
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CASINO AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2310
Mailing Address - Country:US
Mailing Address - Phone:908-499-3691
Mailing Address - Fax:
Practice Address - Street 1:311 CASINO AVE
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2310
Practice Address - Country:US
Practice Address - Phone:908-499-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY620972163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant