Provider Demographics
NPI:1043712789
Name:KOONTZ, BRITTANEE NICOLE (CNA)
Entity Type:Individual
Prefix:
First Name:BRITTANEE
Middle Name:NICOLE
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 TRACY RD
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43619-1307
Mailing Address - Country:US
Mailing Address - Phone:419-250-7556
Mailing Address - Fax:419-250-7556
Practice Address - Street 1:1916 TRACY RD
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619-1307
Practice Address - Country:US
Practice Address - Phone:419-250-7556
Practice Address - Fax:419-250-7556
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No251E00000XAgenciesHome Health