Individual
MRS. IDA SUE MONTGOMERY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
301 ANDREWS AVENUE, LYSTER ARMY OUTPATIENT CLINIC, FORT RUCKER, AL 36362
(334) 255-7387
Mailing address
301 ANDREWS AVENUE, LYSTER ARMY OUTPATIENT CLINIC, FORT RUCKER, AL 36362
(334) 255-7387
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
APRN-384
HI
Other
Enumeration date
11/22/2005
Last updated
07/08/2007
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