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NPI Code Detail

MEDICARE: LISA KUNKLE PA-C

MEDICARE:   LISA  KUNKLE  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantMP000802NJ

General Provider Information

NPI Number : 1568494797
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA KUNKLE PA-C
Provider Business Mailing Address
First Line : 622 KINGS HWY
Second Line :
City : MICKLETON
State : NJ
Zip : 08056-1404
Country : US
Telephone Number : 856-332-5613
Fax Number :
Provider Business Practice Location Address
First Line : 107 E MANTUA AVE
Second Line :
City : WENONAH
State : NJ
Zip : 08090-1950
Country : US
Telephone Number : 856-468-6868
Fax Number : 856-464-1855
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 11/23/2010

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Directions to “ LISA KUNKLE PA-C” Practice Location

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