Basic Information
| Provider Information | |||||||||
| NPI: | 1205217684 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONTZ | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2051 SILVERSIDE DR | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708089005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2254906301 | ||||||||
| FaxNumber: | 2257659539 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 W ESPLANADE AVE | ||||||||
| Address2: | STE 210 | ||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700652489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044648588 | ||||||||
| FaxNumber: | 5044648586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2015 | ||||||||
| LastUpdateDate: | 10/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.200834 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 06801502 | 05 | MS | MEDICAID | 2401033 | 05 | LA | MEDICAID |