Provider Demographics
NPI:1285661272
Name:MONTEGARY, CAROL LYNNE (NP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNNE
Last Name:MONTEGARY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:420 N SECOND AVE
Mailing Address - Street 2:100
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1549
Mailing Address - Country:US
Mailing Address - Phone:208-265-2242
Mailing Address - Fax:208-265-8214
Practice Address - Street 1:420 N SECOND AVE
Practice Address - Street 2:100
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1549
Practice Address - Country:US
Practice Address - Phone:208-265-2242
Practice Address - Fax:208-265-8214
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDNP-726A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ-64384Medicare UPIN