| NPI | 1396158879 |
|---|---|
| Former Name | JENNIFER RENEE MONTGOMERY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WI 318223) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MN 073197) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2014-06-03 |