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General NPI Number Information
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NPI Number | 1245319169
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Entity Type | Individual
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Provider Name | SHAE NOELLE MONTEGNA PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 06/25/2024
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Provider Practice Location Address
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Address Line | 650 N DEVINE RD STE B
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City | VANCOUVER
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State | WA
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Zip | 98661-6979
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Country | US
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Telephone | 360-952-4457
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Fax | 360-828-7409
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Provider Business Mailing Address
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Address Line | 18 NW 20TH AVE
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City | BATTLE GROUND
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State | WA
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Zip | 98604-4175
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Country | US
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Telephone | 360-952-4457
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Fax | 360-828-7409
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | OR PA00727
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA00727
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License Number State | OR
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