Provider Demographics
NPI:1790235166
Name:MONTGOMERY, DIEGUITA ANN (RN)
Entity Type:Individual
Prefix:
First Name:DIEGUITA
Middle Name:ANN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DIEGUITA
Other - Middle Name:ANN
Other - Last Name:VELASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:140 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3113
Mailing Address - Country:US
Mailing Address - Phone:541-774-8201
Mailing Address - Fax:541-774-7979
Practice Address - Street 1:140 S HOLLY ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3113
Practice Address - Country:US
Practice Address - Phone:541-774-8201
Practice Address - Fax:541-774-7979
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR094006479RN163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health