Provider Demographics
NPI:1881440824
Name:KOONTZ, SENECA (RN)
Entity type:Individual
Prefix:
First Name:SENECA
Middle Name:
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9302 RIVER OAKS LN
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4949
Mailing Address - Country:US
Mailing Address - Phone:814-243-5260
Mailing Address - Fax:
Practice Address - Street 1:3940 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-6505
Practice Address - Country:US
Practice Address - Phone:916-567-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95367708163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse