Individual
MARY M MONTAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2730 PROSPERITY AVE STE D, FAIRFAX, VA 22031-4330
(703) 226-2290
Mailing address
2730 PROSPERITY AVE STE D, FAIRFAX, VA 22031-4330
(703) 226-2290
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024173093
VA
Other
Enumeration date
12/16/2015
Last updated
10/10/2022
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