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General NPI Number Information
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NPI Number | 1467981787
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Entity Type | Individual
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Provider Name | STEPHANIE MARIE MONTGOMERY
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Gender | Female
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 06/09/2017
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Provider Practice Location Address
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Address Line | 219 S WASHINGTON ST
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City | EASTON
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State | MD
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Zip | 21601-2913
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Country | US
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Telephone | 410-310-6245
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Fax |
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Provider Business Mailing Address
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Address Line | 305 DEVON DR
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City | CHESTERTOWN
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State | MD
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Zip | 21620-3366
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Country | US
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Telephone | 202-257-7712
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R189729
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License Number State | MD
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