Healthcare Provider Details

I. General information

NPI: 1780297945
Provider Name (Legal Business Name): PETER MICHAEL HUNKUS III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BOARDMAN CANFIELD RD
YOUNGSTOWN OH
44512-4226
US

IV. Provider business mailing address

3976 KINGS GRAVE RD
VIENNA OH
44473
US

V. Phone/Fax

Practice location:
  • Phone: 330-629-2888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027396
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: