Provider Demographics
NPI:1801093190
Name:MONTAGUE, MERI JO (RN, MS, CDDN, APN)
Entity type:Individual
Prefix:MS
First Name:MERI
Middle Name:JO
Last Name:MONTAGUE
Suffix:
Gender:F
Credentials:RN, MS, CDDN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:DAGSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19939-0122
Mailing Address - Country:US
Mailing Address - Phone:302-732-6834
Mailing Address - Fax:
Practice Address - Street 1:18 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1446
Practice Address - Country:US
Practice Address - Phone:302-424-7300
Practice Address - Fax:302-422-1363
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELI-0012270163W00000X
DELY-0000103364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health