Provider Demographics
NPI:1497531594
Name:MUNFORD, KEONDRA
Entity Type:Individual
Prefix:
First Name:KEONDRA
Middle Name:
Last Name:MUNFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7282 HANOVER GREEN DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-1706
Mailing Address - Country:US
Mailing Address - Phone:804-245-4991
Mailing Address - Fax:
Practice Address - Street 1:7282 HANOVER GREEN DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1706
Practice Address - Country:US
Practice Address - Phone:804-245-4991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy