Provider Demographics
NPI:1750003455
Name:PRYAR-FEUTARDO, KORTNY
Entity type:Individual
Prefix:
First Name:KORTNY
Middle Name:
Last Name:PRYAR-FEUTARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 BOLIN TER
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8868
Mailing Address - Country:US
Mailing Address - Phone:970-773-3827
Mailing Address - Fax:
Practice Address - Street 1:542 BOLIN TER
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8868
Practice Address - Country:US
Practice Address - Phone:970-773-3827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula