Healthcare Provider Details

I. General information

NPI: 1508129834
Provider Name (Legal Business Name): MEGHAN KUNZ MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 W 100 S STE 108
LOGAN UT
84321-4551
US

IV. Provider business mailing address

95 W 100 S STE 108
LOGAN UT
84321-4551
US

V. Phone/Fax

Practice location:
  • Phone: 435-881-5703
  • Fax:
Mailing address:
  • Phone: 435-881-5703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number323493-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number323493-8900
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number323493-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: