MEDICARE: EMILY KUNZ-BROCKMAN DO

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	207Q00000X	Family Medicine Physician	OP61355767	WA

General Provider Information

NPI Number	:	1407419542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY KUNZ-BROCKMAN DO

Provider Business Mailing Address
First Line	:	1400 E KINCAID ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	819 S 13TH ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4112
Country	:	US
Telephone Number	:	360-814-6230
Fax Number	:	360-814-6240

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

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	10/26/2022

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