Provider Demographics
NPI:1043510092
Name:KUNTZ, HEATHER ANNE (MSN, RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 880
Mailing Address - Street 2:
Mailing Address - City:ST. IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:380 MISSION DRIVE
Practice Address - Street 2:
Practice Address - City:ST. IGNATUIS
Practice Address - State:MT
Practice Address - Zip Code:59865
Practice Address - Country:US
Practice Address - Phone:406-745-3525
Practice Address - Fax:406-745-4233
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT31562163W00000X
OR201504064RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse