Individual
MRS. JEANETTE RUTH MONTGOMERY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
C.N.P.
Contact information
Practice address
12647 OLIVE BLVD, SUITE 600, SAINT LOUIS, MO 63141-6345
(800) 325-3982
Mailing address
8487 COUNTY ROAD 107, NISSWA, MN 56468
(218) 568-8485
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
20040006-22
MN
Other
Enumeration date
12/09/2005
Last updated
07/08/2007
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