Tangala Sue Montgomery, LPN
Individual provider Active NPI Licensed Practical Nurse · Freeport, OH
NPI 1063041663 · NPPES record last updated Apr 6, 2020
Key facts
- NPI
- 1063041663
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 083268 (OH)
- Practice address
- 19253 Sligo Rd
Freeport, OH 43973-9660 - Phone
- (740) 260-0821
- NPI assigned
- Apr 6, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 083268 | OH | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 083268 | OH | Yes |
Addresses
Primary practice location
19253 Sligo Rd
Freeport, OH 43973-9660
Mailing address
19253 Sligo Rd
Freeport, OH 43973-9660
Other names
- Tangala Sue Quillin
Other providers in Freeport, OH
- Antrim Community Volunteer Fire Department
- Richard B Luyster
- Ohio Hills Health Services
- Ohio Hills Health Services
- Carol Seeley
- Carolyn Xin
All providers in Freeport, OH · Licensed Practical Nurse in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.