MEDICARE: GENEEN MONTGOMERY LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LPN.159854-MEDS-IV	OH

General Provider Information

NPI Number	:	1487188777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENEEN MONTGOMERY LPN

Provider Business Mailing Address
First Line	:	4600 MONTGOMERY RD STE 400
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 TRAILWOOD DR
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-5007
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2017
Last Update Date	:	06/04/2026

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