Individual
SANDRA MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18960 MOON ST, GROSSE POINTE, MI 48236-2026
(313) 283-7311
Mailing address
18960 MOON ST, GROSSE POINTE, MI 48236-2026
(313) 283-7311
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703112683
MI
Other
Enumeration date
01/22/2016
Last updated
01/22/2016
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