Provider Demographics
NPI:1275511636
Name:KOONTZ, ELIZABETH ALLEN STUKEY (MSN RN CS)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ALLEN STUKEY
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:MSN RN CS
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Mailing Address - Street 1:19 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-2212
Mailing Address - Country:US
Mailing Address - Phone:717-263-7758
Mailing Address - Fax:717-261-1147
Practice Address - Street 1:19 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2212
Practice Address - Country:US
Practice Address - Phone:717-263-7758
Practice Address - Fax:717-261-1147
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PARN 31456667L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
083906OtherAM NURSES CRED CTR ANCC