Provider Demographics
NPI:1801658554
Name:DOULA KOKO
Entity type:Organization
Organization Name:DOULA KOKO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KORTNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRYAR FEUTARDO
Authorized Official - Suffix:
Authorized Official - Credentials:CD/PCD (DONA)
Authorized Official - Phone:970-773-3827
Mailing Address - Street 1:68 WATKINS PARK DR # 4010
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9996
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty