Healthcare Provider Details

I. General information

NPI: 1063710937
Provider Name (Legal Business Name): BARBARA JANE KUNNEN MS, RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N WASHINGTON ST
BOURBON IN
46504-1623
US

IV. Provider business mailing address

707 E CEDAR ST STE 200
SOUTH BEND IN
46617-2057
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-7850
  • Fax: 574-335-0755
Mailing address:
  • Phone: 574-335-8700
  • Fax: 574-335-0741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003229A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: