Provider Demographics
NPI:1942455597
Name:MONTGOMERY, ERNALYN C (MSN, FNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ERNALYN
Middle Name:C
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MSN, FNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 EXECUTIVE PARK STE 275
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4708
Mailing Address - Country:US
Mailing Address - Phone:949-229-0323
Mailing Address - Fax:
Practice Address - Street 1:34 EXECUTIVE PARK STE 275
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4708
Practice Address - Country:US
Practice Address - Phone:949-229-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14445363LF0000X, 363LP0808X
AZAP2317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily