Provider Demographics
NPI:1619140944
Name:MONTGOMERY, SUSAN VERONICA (RN, BSN, OCN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:VERONICA
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:RN, BSN, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:333 COTTMAN AVE # C227
Mailing Address - Street 2:FOX CHASE CANCER CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2434
Mailing Address - Country:US
Mailing Address - Phone:215-728-2405
Mailing Address - Fax:215-728-4061
Practice Address - Street 1:333 COTTMAN AVE # C227
Practice Address - Street 2:FOX CHASE CANCER CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2434
Practice Address - Country:US
Practice Address - Phone:215-728-2405
Practice Address - Fax:215-728-4061
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN503509L163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology