1881695682 NPI number — MRS. ROSEMARIE ABID MONTGOMERY FNP-C

Table of content: MRS. ROSEMARIE ABID MONTGOMERY FNP-C (NPI 1881695682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881695682 NPI number — MRS. ROSEMARIE ABID MONTGOMERY FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
ROSEMARIE
Provider Middle Name:
ABID
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881695682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
985 BERKSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
WYOMISSING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19610-1268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-374-5599
Provider Business Mailing Address Fax Number:
610-375-1262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
985 BERKSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WYOMISSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19610-1268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-374-5599
Provider Business Practice Location Address Fax Number:
610-375-1262
Provider Enumeration Date:
08/03/2005

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:  SP009300 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1022183940001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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