Provider Demographics
NPI:1093580995
Name:KUNTZ, BRANDI MICHELLE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:MICHELLE
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:BELFIELD
Mailing Address - State:ND
Mailing Address - Zip Code:58622-7226
Mailing Address - Country:US
Mailing Address - Phone:701-264-9175
Mailing Address - Fax:
Practice Address - Street 1:304 2ND ST NE
Practice Address - Street 2:
Practice Address - City:BELFIELD
Practice Address - State:ND
Practice Address - Zip Code:58622-7226
Practice Address - Country:US
Practice Address - Phone:701-264-9175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant