CAROLYN A MONTGOMERY (NPI# 1588769913) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588769913 |
| Entity Type | Individual |
| Full Name | CAROLYN A MONTGOMERY |
| Other Name | CAROLYN S AVAU |
| Credential | PA-C |
| Practice Address |
9555 Upland Ln N Maple Grove MN 55369-4485 |
| Practice Telephone | 9529931440 |
| Mailing Telephone | 9529931440 |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2020-02-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 13212 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 10000785A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | BCBS - GATEWAY | 000000381096 | 01 |
| IN | BCBS - MARY STREET | 000000367990 | 01 |
| KY | 95005716 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518285857 | Carolyn Daniele' Montgomery | Licensed Practical Nurse | 1429 Van Fleet Ave, Cincinnati, OH 45231-4424 | 2010-05-11 |
| 1487283008 | Carolyn Montgomery | Physical Therapist | 175 S Union Blvd, Colorado Springs, CO 80910-3113 | 2020-04-06 |
| 1710283734 | Carolyn Montgomery | Physical Therapist | 8254 Atlee Rd, Mechanicsville, VA 23116-1844 | 2011-02-09 |
| 1720053416 | Carolyn A Montgomery | Nurse Practitioner | 50 Lakefront Blvd, Suite 130, Buffalo, NY 14202-4345 | 2006-02-17 |
| Street Address |
9555 UPLAND LN N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369-4485 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568453926 | David C Sandell | Family Medicine | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2005-11-03 |
| 1114528593 | Dana Marie Feia | Physician Assistant | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2020-11-03 |
| 1235741364 | Relevium Chiropractic Care Pa | Chiropractor | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2020-08-19 |
| 1467012872 | Bethany Wysocki | Audiologist | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2019-06-18 |
| 1487168357 | Dusty Renee Hackler | Psychologist | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2017-11-29 |
| 1841722469 | Brynne Rainier Wilson Latterell | Family Medicine | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2017-04-02 |
| 1982150728 | Park Nicollet | Clinic/Center | 9555 Upland Ln N, Maple Grove, MN 66369 | 2016-08-31 |
| 1528514932 | David Chollar | Social Worker | 9555 Upland Ln N, Behavioral Health, 3rd Floor, Maple Grove, MN 55369-4485 | 2016-08-27 |
| 1770037574 | Biye Tambang | Nurse Practitioner | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2016-08-09 |
| 1174975528 | Park Nicollet | Clinic/Center | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2016-07-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295341055 | Alexandra M Fischer | Physician Assistant | 6256 Juneau Ln N, Maple Grove, MN 55311-4137 | 2020-09-17 |
| 1720608763 | Alexa Olson | Physician Assistant | 9049 Archer Ct N, Maple Grove, MN 55311-1826 | 2020-04-20 |
| 1932754538 | Michaela Rose Patton | Physician Assistant | 17649 93rd Pl N, Maple Grove, MN 55311-4436 | 2019-08-09 |
| 1063894129 | Kristen Marie Finnegan | Physician Assistant | 9855 Hospital Dr # 102a, Maple Grove, MN 55369-4648 | 2015-06-25 |
| 1891070694 | Jennifer L Waite | Physician Assistant | 9825 Hospital Dr Ste 205, Maple Grove, MN 55369-4480 | 2011-10-12 |
| 1851621635 | Charise Michde Mehrkens | Physician Assistant | 9855 Hospital Drive Suite 102 A, North Memorial Urgent Care Maple Grove, Maple Grove, MN 55369 | 2009-12-30 |
| 1457579450 | Cynthia C Cassel | Physician Assistant | 6300 Wedgewood Way, Maple Grove, MN 55311 | 2007-04-23 |
| 1649348426 | Timothy Joseph Montag | Physician Assistant | 9645 Grove Circle North, Ste 200, Maple Grove, MN 55369-4466 | 2006-12-01 |
| 1760434211 | Frederick E Demeuse | Physician Assistant | 6545 E Fish Lake Rd, Maple Grove, MN 55369-6005 | 2006-05-16 |
| 1114528593 | Dana Marie Feia | Physician Assistant | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2020-11-03 |
| Find all providers in MAPLE GROVE | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.