Healthcare Provider Details

I. General information

NPI: 1255480489
Provider Name (Legal Business Name): LAUREN B MONTGOMERY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 FLOWOOD DR STE 400
FLOWOOD MS
39232-9307
US

IV. Provider business mailing address

2550 FLOWOOD DR STE 400
FLOWOOD MS
39232-9307
US

V. Phone/Fax

Practice location:
  • Phone: 601-933-9521
  • Fax: 601-933-9525
Mailing address:
  • Phone: 601-933-9521
  • Fax: 601-933-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR865709
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: