=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962672725
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA LOU KUNZ RN MSN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2008
-----------------------------------------------------
Last Update Date | 03/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3606 N 114TH AVE
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68164-2769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-493-2941
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3606 N 114TH AVE
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68164-2769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-493-2941
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WM0705X
-----------------------------------------------------
Taxonomy Name | Medical-Surgical Registered Nurse
-----------------------------------------------------
License Number | 27470
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------