Provider Demographics
NPI:1821677600
Name:MONTGOMERY, DIONNE LASHAWN (CNM)
Entity type:Individual
Prefix:
First Name:DIONNE
Middle Name:LASHAWN
Last Name:MONTGOMERY
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:DIONNE
Other - Middle Name:LASHAWN
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 IDITAROD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3732
Mailing Address - Country:US
Mailing Address - Phone:702-755-5019
Mailing Address - Fax:
Practice Address - Street 1:1650 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5907
Practice Address - Country:US
Practice Address - Phone:907-459-3540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172801163W00000X
UT11868743-4402176B00000X
AK189197176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1821677600Medicaid
AK1821677600Medicaid