Healthcare Provider Details

I. General information

NPI: 1053028316
Provider Name (Legal Business Name): VICKI ELAINE MONTGOMERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 EASY ST STE 202
UNIONTOWN PA
15401-3128
US

IV. Provider business mailing address

205 EASY ST STE 202
UNIONTOWN PA
15401-3128
US

V. Phone/Fax

Practice location:
  • Phone: 724-912-7510
  • Fax:
Mailing address:
  • Phone: 724-912-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN531845
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: