Healthcare Provider Details

I. General information

NPI: 1750003455
Provider Name (Legal Business Name): KORTNY PRYAR-FEUTARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 01/22/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 BOLIN TER
UPPER MARLBORO MD
20774-8868
US

IV. Provider business mailing address

542 BOLIN TER
UPPER MARLBORO MD
20774-8868
US

V. Phone/Fax

Practice location:
  • Phone: 970-773-3827
  • Fax:
Mailing address:
  • Phone: 970-773-3827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: