Maryalice Montgomery, RN CNOR RNFA

Primary specialty

Registered Nurse First AssistantTaxonomy code 163WR0006X

License

24088 Issued in AK

Practice address

21309 Lowland Ave
Eagle River, AK 99577-9565

Phone

(907) 622-6222

NPI assigned

Oct 31, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225411200000",
    "number": "1407009665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21309 LOWLAND AVE",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995779565",
            "telephone_number": "907-622-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21309 LOWLAND AVE",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995779565",
            "telephone_number": "907-622-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "MARYALICE",
        "name_prefix": "Mrs.",
        "credential": "RN CNOR RNFA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-31",
        "last_updated": "2008-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "AK",
            "license": "24088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Lynn Miller
• Mind, Body, Soul
• David L Mischel, APRN
• Katelynn Mobley
• Gary Mogg
• Courtney Sherrill Moody, LCSW, LCADC
• Lucy Truth Moody
• Jeanne Moore-Kettell
• Christian John Moore, MSN, APRN, FNP-C
• Kaitlyn Andrea Moore, OD

• Registered Nurse First Assistant in Eagle River, AK
• Providers in Eagle River, AK by specialty
• Registered Nurse First Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.