Provider Demographics
NPI:1184085268
Name:MONTGOMERY, BROOKE (FNP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E FRONT ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-1725
Mailing Address - Country:US
Mailing Address - Phone:302-280-6358
Mailing Address - Fax:302-280-6321
Practice Address - Street 1:116 E FRONT ST STE A
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-1725
Practice Address - Country:US
Practice Address - Phone:765-265-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28160822A163W00000X, 363LF0000X
DELG-0011527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse