Provider Demographics
NPI:1265206874
Name:MONTGOMERY, JANAI LATRISE (LPN)
Entity type:Individual
Prefix:
First Name:JANAI
Middle Name:LATRISE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48505-5323
Mailing Address - Country:US
Mailing Address - Phone:810-620-6541
Mailing Address - Fax:
Practice Address - Street 1:601 E STEWART AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-5323
Practice Address - Country:US
Practice Address - Phone:810-620-6541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703122873164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse