Healthcare Provider Details

I. General information

NPI: 1366824757
Provider Name (Legal Business Name): JILL ANNE KUNISCH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 N REYNOLDS RD SUITE 160
TOLEDO OH
43615-2068
US

IV. Provider business mailing address

5855 MONROE ST
SYLVANIA OH
43560-2269
US

V. Phone/Fax

Practice location:
  • Phone: 419-578-4260
  • Fax: 419-578-5630
Mailing address:
  • Phone: 419-824-7451
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG0615058
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG0615058
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: