Healthcare Provider Details

I. General information

NPI: 1205217684
Provider Name (Legal Business Name): EMILY ELIZABETH MONTZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ESPLANADE AVE STE 210
KENNER LA
70065-2489
US

IV. Provider business mailing address

2051 SILVERSIDE DR SUITE 260
BATON ROUGE LA
70808-9005
US

V. Phone/Fax

Practice location:
  • Phone: 504-464-8588
  • Fax: 504-464-8586
Mailing address:
  • Phone: 225-490-6301
  • Fax: 225-765-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.200834
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: