Provider Demographics
NPI:1316743131
Name:MONTGOMERY, TANA Y
Entity type:Individual
Prefix:
First Name:TANA
Middle Name:Y
Last Name:MONTGOMERY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 NE 65TH. ST.
Mailing Address - Street 2:PMB 82811
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13718 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4746
Practice Address - Country:US
Practice Address - Phone:425-243-2739
Practice Address - Fax:253-584-2649
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No372600000XNursing Service Related ProvidersAdult Companion