Healthcare Provider Details

I. General information

NPI: 1801016696
Provider Name (Legal Business Name): CONNIE KUNKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SE CROSS MENTAL HEALTH CENTERS OF WESTERN ILLINOIS
MT STERLING IL
62353
US

IV. Provider business mailing address

RR 3 BOX 20
MT STERLING IL
62353
US

V. Phone/Fax

Practice location:
  • Phone: 217-773-3325
  • Fax: 217-773-2425
Mailing address:
  • Phone: 217-773-3325
  • Fax: 217-773-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: