MEDICARE: MELISSA KUNZE LPN

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
1	164W00000X	Licensed Practical Nurse	317601-13	WI

General Provider Information

NPI Number	:	1902234321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA KUNZE LPN

Provider Business Mailing Address
First Line	:	3420 COUNTY Q
Second Line	:
City	:	PELICAN LAKE
State	:	WI
Zip	:	54463-9527
Country	:	US
Telephone Number	:	715-550-5413
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 COUNTY Q
Second Line	:
City	:	PELICAN LAKE
State	:	WI
Zip	:	54463-9527
Country	:	US
Telephone Number	:	715-550-5413
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2013
Last Update Date	:	10/22/2013

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