Provider Demographics
NPI:1720643885
Name:MOUNTZ, MARCIA LYNNE (LPN)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYNNE
Last Name:MOUNTZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 TOWNSHIP ROAD 121
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-9770
Mailing Address - Country:US
Mailing Address - Phone:614-361-7322
Mailing Address - Fax:
Practice Address - Street 1:5015 TOWNSHIP ROAD 121
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-9770
Practice Address - Country:US
Practice Address - Phone:614-361-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH056948164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse