Healthcare Provider Details

I. General information

NPI: 1821677600
Provider Name (Legal Business Name): DIONNE LASHAWN MONTGOMERY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIONNE LASHAWN KELLEY

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 AIRPORT WAY STE 5
FAIRBANKS AK
99709-4772
US

IV. Provider business mailing address

402 IDITAROD AVE
FAIRBANKS AK
99701-3732
US

V. Phone/Fax

Practice location:
  • Phone: 907-415-1002
  • Fax: 907-885-2031
Mailing address:
  • Phone: 702-755-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number189197
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number172801
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number11868743-4402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: