Provider Demographics
NPI:1538692694
Name:KIENTZLER, SANDY LYNN (CD(DONA))
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:LYNN
Last Name:KIENTZLER
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17090 CHANNEL ST
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-2218
Mailing Address - Country:US
Mailing Address - Phone:510-294-9926
Mailing Address - Fax:
Practice Address - Street 1:17090 CHANNEL ST
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-2218
Practice Address - Country:US
Practice Address - Phone:510-294-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10452374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
1217363OtherDONA