Individual
MR. MATTHEW CARL MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA, MS
Contact information
Practice address
2222 N LINCOLN AVE, YORK, NE 68467-1030
(402) 362-6671
Mailing address
804 KINGSLEY AVE, YORK, NE 68467-4129
(402) 440-4141
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
100902
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NE 901660
—
NE
01
—
P00273623
RAILROAD NUMBER
NE
Enumeration date
08/13/2006
Last updated
07/08/2007
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