Provider Demographics
NPI:1922697044
Name:PONTIUS, AMY (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PONTIUS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 ALDEN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1368
Mailing Address - Country:US
Mailing Address - Phone:281-804-4586
Mailing Address - Fax:
Practice Address - Street 1:2510 S LOOP 336 W STE 215-H
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3701
Practice Address - Country:US
Practice Address - Phone:281-305-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654941163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant