Provider Demographics
NPI:1174854491
Name:MONTGOMERY, DEVON SUE (STNA)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:SUE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 FORESTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1493
Mailing Address - Country:US
Mailing Address - Phone:740-477-3752
Mailing Address - Fax:
Practice Address - Street 1:506 FORESTVIEW CT
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1493
Practice Address - Country:US
Practice Address - Phone:740-477-3752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400683971107376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide