MEDICARE: MRS. STACY LAMONTAGNA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704336065	MI

General Provider Information

NPI Number	:	1003323775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY LAMONTAGNA NP

Provider Business Mailing Address
First Line	:	PO BOX 249
Second Line	:	801 HAZEN STREET, SUITE C
City	:	PAW PAW
State	:	MI
Zip	:	49079-0249
Country	:	US
Telephone Number	:	269-657-5574
Fax Number	:	269-657-3474

Provider Business Practice Location Address
First Line	:	803 W ARLINGTON ST
Second Line	:
City	:	BANGOR
State	:	MI
Zip	:	49013-1108
Country	:	US
Telephone Number	:	269-427-6810
Fax Number	:	269-427-6811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2018
Last Update Date	:	01/08/2026

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