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Individual
JANESSA ANNETTE MONTGOMERY
Active
Individual
JANESSA ANNETTE MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
C154761
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C154761
STATE LICENSE
IA
Enumeration date
10/02/2019
Last updated
10/02/2019
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