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Individual

SHANON DAVID MONTGOMERY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
440 WOODWARD AVE, IRON MOUNTAIN, MI 49801-4631
(906) 776-9040
(906) 774-7279
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704217286
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AG0216095
AMERICAN ACADEMY OF NURSE PRACTITIONERS
Enumeration date
03/01/2016
Last updated
02/14/2020
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