Provider Demographics
NPI:1518965300
Name:MONTGOMERY, ELIZABETH A (CRNP-A)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:CRNP-A
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64531
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4531
Mailing Address - Country:US
Mailing Address - Phone:410-280-6568
Mailing Address - Fax:410-280-6515
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 430
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-2720
Practice Address - Fax:410-224-0209
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR043688363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ09294Medicare UPIN