Healthcare Provider Details

I. General information

NPI: 1003342551
Provider Name (Legal Business Name): KATHERINE E. KUNNEN DNP, FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE ELIZABETH EUNJEE PRUSS DNP, FNP-C

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 36TH ST SE
GRAND RAPIDS MI
49512-2810
US

IV. Provider business mailing address

107 ALTEN AVE NE
GRAND RAPIDS MI
49503-3703
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2110
  • Fax: 616-942-9548
Mailing address:
  • Phone: 734-223-4562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704274169
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704274169
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: