Individual
MARY KOONTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, IBCLC
Contact information
Practice address
3300 RIVERMONT AVE, LYNCHBURG, VA 24503-2030
(434) 200-3000
Mailing address
39 MOSBY CT, RUSTBURG, VA 24588-4614
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
0001281123
VA
Other
Enumeration date
03/29/2024
Last updated
03/29/2024
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