MEDICARE: JADE R MONTGOMERY

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	163W00000X	Registered Nurse	RN.389963	OH

General Provider Information

NPI Number	:	1952086803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE R MONTGOMERY

Provider Business Mailing Address
First Line	:	2868 COMPTON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-2634
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2868 COMPTON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-2634
Country	:	US
Telephone Number	:	513-712-8182
Fax Number	:

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

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	06/19/2023

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Directions to “ JADE R MONTGOMERY ” Practice Location

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