Individual
MR. JUSTIN BERNARD MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1 MEDICAL DR, ATTN CENTERS FOR HEALTHY AGING, LEBANON, NH 03756-1000
(603) 650-5000
Mailing address
1 MEDICAL DR, ATTN CENTERS FOR HEALTHY AGING, LEBANON, NH 03756-1000
(603) 650-5000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
052034-23
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019890
—
VT
05
—
3082773
—
NH
Enumeration date
04/28/2011
Last updated
12/05/2014
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