Provider Demographics
NPI:1750476511
Name:MONTAGUE, PATRICK J (CRNA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:MONTAGUE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39W550 W HALADAY LN
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4853
Mailing Address - Country:US
Mailing Address - Phone:630-761-8202
Mailing Address - Fax:
Practice Address - Street 1:39W550 W HALADAY LN
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4853
Practice Address - Country:US
Practice Address - Phone:630-761-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered