MEDICARE: MRS. JOHNNA KUNKLE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula
2	163WL0100X	Lactation Consultant (Registered Nurse)	524040	CA

General Provider Information

NPI Number	:	1033842224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOHNNA KUNKLE RN

Provider Business Mailing Address
First Line	:	3433 LEES AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3010
Country	:	US
Telephone Number	:	562-882-7260
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 LEES AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3010
Country	:	US
Telephone Number	:	562-882-7260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2022
Last Update Date	:	08/12/2025

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