Provider Demographics
NPI:1396763686
Name:MONTGOMERY, LA SHEL NIKOLE (CNM)
Entity type:Individual
Prefix:MRS
First Name:LA SHEL
Middle Name:NIKOLE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6075 PASEO PRADERA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-2241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 ENCINITAS BLVD
Practice Address - Street 2:101
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3737
Practice Address - Country:US
Practice Address - Phone:760-213-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1673176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife