Individual
SUSAN LEIGH MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
122 WEISENBERGER ROAD, MADISON, MS 39110-8561
(601) 790-9080
(601) 790-9098
Mailing address
122 WEISENBERGER ROAD, MADISON, MS 39110-8561
(601) 790-9080
(601) 790-9098
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R524174
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00116067
—
MS
Enumeration date
06/24/2010
Last updated
02/03/2011
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