Provider Demographics
NPI:1962237859
Name:MONTGOMERY, SANDRA K
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 VACATIONLAND DR
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9676
Mailing Address - Country:US
Mailing Address - Phone:989-370-6546
Mailing Address - Fax:
Practice Address - Street 1:7403 W OTSEGO LAKE DR
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-7931
Practice Address - Country:US
Practice Address - Phone:989-370-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide