Provider Demographics
NPI:1316911357
Name:LAMONTAGNE, HENRIETTA E (PA-C)
Entity type:Individual
Prefix:MS
First Name:HENRIETTA
Middle Name:E
Last Name:LAMONTAGNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:412 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:PA
Practice Address - Zip Code:18810-1618
Practice Address - Country:US
Practice Address - Phone:570-888-9655
Practice Address - Fax:570-888-3842
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000040L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA970021499OtherRAILROAD MEDICARE
PACC9269OtherRR PA MEDICARE GROUP
PAGU039830OtherPA MEDICARE GROUOP
PA051230N8YMedicare PIN
PA970021499OtherRAILROAD MEDICARE