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General NPI Number Information
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NPI Number | 1811510506
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Entity Type | Individual
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Provider Name | KRISTA WUNSCH PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 1616 GRAND AVE STE A
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City | WAUKEGAN
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State | IL
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Zip | 60085-3676
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Country | US
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Telephone | 847-249-1733
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Fax | 847-782-4515
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Provider Business Mailing Address
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Address Line | 1616 GRAND AVE STE A
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City | WAUKEGAN
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State | IL
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Zip | 60085-3676
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Country | US
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Telephone | 847-249-1733
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Fax | 847-782-4515
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085008391
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License Number State | IL
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