Provider Demographics
NPI:1679956015
Name:MONTANA, JADE (NP, CNM)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:MONTANA
Suffix:
Gender:F
Credentials:NP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 PRICE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-8016
Mailing Address - Country:US
Mailing Address - Phone:919-360-3569
Mailing Address - Fax:
Practice Address - Street 1:3200 NORTHLINE AVE STE 130
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7600
Practice Address - Country:US
Practice Address - Phone:919-360-3569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007746363LF0000X
NCCNM05541367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily