Provider Demographics
NPI:1205217684
Name:MONTZ, EMILY ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:MONTZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2051 SILVERSIDE DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9005
Mailing Address - Country:US
Mailing Address - Phone:225-490-6301
Mailing Address - Fax:225-765-9539
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:STE 210
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2489
Practice Address - Country:US
Practice Address - Phone:504-464-8588
Practice Address - Fax:504-464-8586
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200834363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06801502Medicaid
LA2401033Medicaid
LA525649YH3UMedicare PIN