Healthcare Provider Details

I. General information

NPI: 1326973660
Provider Name (Legal Business Name): DANA KUNDERT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 16TH AVE STE 3
MONROE WI
53566-1763
US

IV. Provider business mailing address

925 16TH AVE STE 3
MONROE WI
53566-1763
US

V. Phone/Fax

Practice location:
  • Phone: 608-328-7171
  • Fax:
Mailing address:
  • Phone: 608-328-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201785-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: