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General NPI Number Information
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NPI Number | 1508098310
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Entity Type | Individual
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Provider Name | DAVID DOUGLAS KUNZ
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Gender | Male
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Dates
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Enumeration Date | 08/12/2009
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 3360 WASHINGTON PKWY STE 2
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8333
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Country | US
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Telephone | 208-932-7024
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Fax | 208-904-4447
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Provider Business Mailing Address
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Address Line | 6405 S 3000 E STE 201
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-6990
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Country | US
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Telephone | 801-266-3113
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Fax | 801-266-5633
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 76011
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License Number State | ID
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