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General NPI Number Information
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NPI Number | 1366205072
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Entity Type | Individual
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Provider Name | JENNIFER L KUNKEL CNA
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Gender | Female
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | N9671 DEER LAKE LN
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City | PHILLIPS
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State | WI
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Zip | 54555-7761
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Country | US
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Telephone | 715-339-6706
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Fax |
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Provider Business Mailing Address
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Address Line | 765 FLAMBEAU AVE UPPR
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City | PHILLIPS
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State | WI
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Zip | 54555-1013
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Country | US
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Telephone | 715-820-0459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 321478
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License Number State | WI
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