Provider Demographics
NPI:1326544610
Name:MONTGOMERY, EDITH CHINYERE (RN)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:CHINYERE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 N MACARTHUR BLVD APT 2017
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7648
Mailing Address - Country:US
Mailing Address - Phone:469-583-9678
Mailing Address - Fax:
Practice Address - Street 1:8005 N MACARTHUR BLVD APT 2017
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7648
Practice Address - Country:US
Practice Address - Phone:469-583-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX907848163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health