Provider Demographics
NPI:1144561796
Name:KUNKEL, JERICA BURNICE (LPN)
Entity Type:Individual
Prefix:
First Name:JERICA
Middle Name:BURNICE
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 W MARTINDALE RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2927
Mailing Address - Country:US
Mailing Address - Phone:937-751-3590
Mailing Address - Fax:
Practice Address - Street 1:817 W MARTINDALE RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:OH
Practice Address - Zip Code:45322-2927
Practice Address - Country:US
Practice Address - Phone:937-751-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143649164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse