Provider Demographics
NPI:1568216042
Name:MONTGOMERY, ISABELLE LISA (CD)
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:LISA
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84055-0736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5795 N STARR LN
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:UT
Practice Address - Zip Code:85055
Practice Address - Country:US
Practice Address - Phone:385-910-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula