MEDICARE: JANE F MONTGOMERY RN 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	363LA2200X	Adult Health Nurse Practitioner	230962	TX

General Provider Information

NPI Number	:	1114183084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE F MONTGOMERY RN NP

Provider Business Mailing Address
First Line	:	PO BOX 8567
Second Line	:
City	:	BACLIFF
State	:	TX
Zip	:	77518-8567
Country	:	US
Telephone Number	:	281-339-2213
Fax Number	:	281-335-4529

Provider Business Practice Location Address
First Line	:	6417 MEMORIAL DR
Second Line	:	SUITE B
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-4058
Country	:	US
Telephone Number	:	281-339-2213
Fax Number	:	281-335-4529

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

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	07/31/2008

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