Provider Demographics
NPI:1093215055
Name:GUDGER, KUNHEE (RN)
Entity Type:Individual
Prefix:
First Name:KUNHEE
Middle Name:
Last Name:GUDGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18211 KELLY BLVD APT 1535
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-4644
Mailing Address - Country:US
Mailing Address - Phone:903-474-4466
Mailing Address - Fax:
Practice Address - Street 1:13601 PRESTON RD STE 210W
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4986
Practice Address - Country:US
Practice Address - Phone:855-452-6435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX858881163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse