Provider Demographics
NPI:1255633855
Name:MONTGOMERY, SANDRA KAY (SANDRA MONTGOMERY)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:SANDRA MONTGOMERY
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:KAY
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SANDRA MONTGOMERY
Mailing Address - Street 1:4314 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-2838
Mailing Address - Country:US
Mailing Address - Phone:239-877-7566
Mailing Address - Fax:
Practice Address - Street 1:10110 SOUTH
Practice Address - Street 2:7650 EAST
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-638-3500
Practice Address - Fax:406-638-3382
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 115121163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse