MEDICARE: BEATRIZ KUNKLE

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	164W00000X	Licensed Practical Nurse	310016	NY

General Provider Information

NPI Number	:	1437541489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRIZ KUNKLE

Provider Business Mailing Address
First Line	:	7899 MOUNT MORRIS NUNDA RD
Second Line	:
City	:	MOUNT MORRIS
State	:	NY
Zip	:	14510-9425
Country	:	US
Telephone Number	:	585-447-1776
Fax Number	:

Provider Business Practice Location Address
First Line	:	7899 MOUNT MORRIS NUNDA RD
Second Line	:
City	:	MOUNT MORRIS
State	:	NY
Zip	:	14510-9425
Country	:	US
Telephone Number	:	585-447-1776
Fax Number	:

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

Provider Enumeration Date	:	02/27/2015
Last Update Date	:	02/27/2015

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