Provider Demographics
NPI:1598132177
Name:KOOYMAN, VIRGINIA (VIRGINIA)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:KOOYMAN
Suffix:
Gender:F
Credentials:VIRGINIA
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:
Other - Last Name:KOOYMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLC
Mailing Address - Street 1:1185 PIKEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-4627
Mailing Address - Country:US
Mailing Address - Phone:720-355-4508
Mailing Address - Fax:
Practice Address - Street 1:1185 PIKEVIEW ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4627
Practice Address - Country:US
Practice Address - Phone:720-355-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-30
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN