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General NPI Number Information
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NPI Number | 1457083206
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Entity Type | Individual
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Provider Name | NICHOLAS KUNZE PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | USAF 4102 PINION DRIVE
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City | USAF ACADEMY
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State | CO
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Zip | 80840-2502
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Country | US
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Telephone | 719-333-2025
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 WILFORD HALL LOOP
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City | JBSA LACKLAND
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State | TX
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Zip | 78236-5638
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA17229
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License Number State | TX
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