MEDICARE: JANIE MONTGOMERY

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1649804618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIE MONTGOMERY

Provider Business Mailing Address
First Line	:	1811 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1259
Country	:	US
Telephone Number	:	702-257-9638
Fax Number	:	702-974-1653

Provider Business Practice Location Address
First Line	:	4835 SPHINX WAY APT 1059
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-2863
Country	:	US
Telephone Number	:	702-521-5746
Fax Number	:

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

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	02/27/2020

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Directions to “ JANIE MONTGOMERY ” Practice Location

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