Provider Demographics
NPI:1871209486
Name:MONTAGUE, JULIE CAROL
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:CAROL
Last Name:MONTAGUE
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 1:9282 JILL MARIE LN
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-8613
Mailing Address - Country:US
Mailing Address - Phone:810-447-5160
Mailing Address - Fax:810-644-1024
Practice Address - Street 1:9282 JILL MARIE LN
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-8613
Practice Address - Country:US
Practice Address - Phone:810-447-5160
Practice Address - Fax:810-644-1024
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI802943457374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide