Provider Demographics
NPI:1245929256
Name:MONTGOMERY-BOOKER, LATENA (RN)
Entity type:Individual
Prefix:MRS
First Name:LATENA
Middle Name:
Last Name:MONTGOMERY-BOOKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6960 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-3342
Mailing Address - Country:US
Mailing Address - Phone:405-210-4390
Mailing Address - Fax:
Practice Address - Street 1:6960 CEDAR CT
Practice Address - Street 2:
Practice Address - City:OVILLA
Practice Address - State:TX
Practice Address - Zip Code:75154-3342
Practice Address - Country:US
Practice Address - Phone:405-210-4390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX796850163WC1500X, 163WI0600X, 163WW0000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WW0000XNursing Service ProvidersRegistered NurseWound Care