Basic Information
| Provider Information | |||||||||
| NPI: | 1073570008 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONTGOMERY | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4120 W MEMORIAL RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731209322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057483300 | ||||||||
| FaxNumber: | 8776575008 | ||||||||
| Practice Location | |||||||||
| Address1: | 4120 W MEMORIAL RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731209322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057483300 | ||||||||
| FaxNumber: | 8776575008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WN0800X | 63831 | OK | Y | Nursing Service Providers | Registered Nurse | Neuroscience |
No ID Information.