Healthcare Provider Details

I. General information

NPI: 1790047017
Provider Name (Legal Business Name): RHONDA LEA MONTGOMERY MSN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 CALDWELL CORNER RD
TOWNSEND DE
19734-9258
US

IV. Provider business mailing address

1581 CALDWELL CORNER RD
TOWNSEND DE
19734-9258
US

V. Phone/Fax

Practice location:
  • Phone: 302-750-7553
  • Fax:
Mailing address:
  • Phone: 302-750-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License NumberLT-0000103
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberLT-0000103
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: