| NPI | 1649753468 |
|---|---|
| Former Name | THERESA RENAE MONTGOMERY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9293072) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2018-09-07 |