Healthcare Provider Details

I. General information

NPI: 1912374034
Provider Name (Legal Business Name): HILARY DAWN MONTGOMERY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 NE BURNSIDE RD BLDG C STE. 503A
GRESHAM OR
97030-6722
US

IV. Provider business mailing address

13203 SE 172ND AVE STE 166-233
HAPPY VALLEY OR
97086-8737
US

V. Phone/Fax

Practice location:
  • Phone: 503-661-7733
  • Fax: 503-661-7890
Mailing address:
  • Phone: 503-661-7733
  • Fax: 503-661-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number201405166RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201907881NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: