Provider Demographics
NPI:1932381183
Name:KNIGHTSBRIDGE, MONTANA (RN)
Entity Type:Individual
Prefix:
First Name:MONTANA
Middle Name:
Last Name:KNIGHTSBRIDGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 BAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4150
Mailing Address - Country:US
Mailing Address - Phone:818-342-5897
Mailing Address - Fax:818-345-6356
Practice Address - Street 1:7101 BAIRD AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4150
Practice Address - Country:US
Practice Address - Phone:818-342-5897
Practice Address - Fax:818-345-6356
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450123163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)