Individual
MS. HENRIETTA E. LAMONTAGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
412 S MAIN ST, ATHENS, PA 18810-1618
(570) 888-9655
(570) 888-3842
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA000040L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970021499
RAILROAD MEDICARE
PA
01
—
CC9269
RR PA MEDICARE GROUP
PA
01
—
GU039830
PA MEDICARE GROUOP
PA
Enumeration date
02/15/2006
Last updated
09/14/2011
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