Provider Demographics
NPI:1528518545
Name:KOONTZ, CAMILLE MARIE (ND)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:MARIE
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 D ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3229
Mailing Address - Country:US
Mailing Address - Phone:360-734-9500
Mailing Address - Fax:
Practice Address - Street 1:1903 D ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3229
Practice Address - Country:US
Practice Address - Phone:360-734-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60697272175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath