Provider Demographics
NPI:1619152543
Name:KUNTZ, MARCY JO (MIDWIFE)
Entity Type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:JO
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4807
Mailing Address - Country:US
Mailing Address - Phone:406-261-8482
Mailing Address - Fax:406-752-6892
Practice Address - Street 1:611 3RD AVE W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4807
Practice Address - Country:US
Practice Address - Phone:406-261-8482
Practice Address - Fax:406-752-6892
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT30176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife