Healthcare Provider Details

I. General information

NPI: 1174665558
Provider Name (Legal Business Name): MARK FREDERICK KUNZINGER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 S LABURNUM AVE
RICHMOND VA
23231-2713
US

IV. Provider business mailing address

10299 WOODMAN RD
GLEN ALLEN VA
23060-4419
US

V. Phone/Fax

Practice location:
  • Phone: 804-236-8752
  • Fax: 804-236-8759
Mailing address:
  • Phone: 804-727-8500
  • Fax: 804-727-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001103649
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: