Healthcare Provider Details

I. General information

NPI: 1700234077
Provider Name (Legal Business Name): DEANNA E. KUNKEL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE 843 DOAN HALL
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

700 ACKERMAN RD SUITE 570
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8536
  • Fax: 614-293-8902
Mailing address:
  • Phone: 614-366-8030
  • Fax: 614-293-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.019561
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number410981
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: