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General NPI Number Information
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NPI Number | 1770855835
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Entity Type | Individual
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Provider Name | JEANINE MARIE KUNA FNP
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Gender | Female
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 320 S SAINT JOSEPH ST SUITE 300
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City | SOUTH BEND
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State | IN
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Zip | 46601-2308
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Country | US
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Telephone | 574-406-6376
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Fax |
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Provider Business Mailing Address
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Address Line | 320 DR MARTIN LUTHER KING JR DR S STE 300
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City | SOUTH BEND
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State | IN
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Zip | 46601-2358
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 71003535A
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License Number State | IN
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