Organization
MEDICAL ASSISTED WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN MONTGOMERY NP (OWNER)
(423) 388-5688
Entity
Organization
Contact information
Practice address
121 WYATT DR STE 3, LAS CRUCES, NM 88005-2960
(575) 495-2000
(575) 495-2000
Mailing address
4216 AURIGA CT, LAS CRUCES, NM 88011-0940
(423) 388-5688
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/21/2017
Last updated
10/13/2017
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