Provider Demographics
NPI:1609103621
Name:MONTAGUE, WENDY (RN, BSN, ICCE, CD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MONTAGUE
Suffix:
Gender:F
Credentials:RN, BSN, ICCE, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 DEERWOOD CREEK EST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:GA
Mailing Address - Zip Code:31565-2301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 DEERWOOD CREEK EST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:GA
Practice Address - Zip Code:31565-2301
Practice Address - Country:US
Practice Address - Phone:912-265-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula