Healthcare Provider Details

I. General information

NPI: 1689983520
Provider Name (Legal Business Name): ASHLEY NICOLE KUNSELMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY JUDY

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21159 PAINT BLVD SUITE 2
SHIPPENVILLE PA
16254-4023
US

IV. Provider business mailing address

121 DOCTORS LN
CLARION PA
16214-8515
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-6770
  • Fax: 814-226-1015
Mailing address:
  • Phone: 814-226-3494
  • Fax: 814-226-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS016629
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: