1992784656 NPI number — COURTNEY LAIRD MONTGOMERY ARNP

Table of content: COURTNEY LAIRD MONTGOMERY ARNP (NPI 1992784656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992784656 NPI number — COURTNEY LAIRD MONTGOMERY ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
COURTNEY
Provider Middle Name:
LAIRD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DECKER
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
LAIRD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992784656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1031
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALL CITY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98024-1031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-222-5778
Provider Business Mailing Address Fax Number:
425-644-7318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4140 FACTORIA BLVD SE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98006-5261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-644-2273
Provider Business Practice Location Address Fax Number:
425-644-7318
Provider Enumeration Date:
01/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP30007068 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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