Provider Demographics
NPI:1174186712
Name:KUNKEL, MARIA LOURDES (RN)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LOURDES
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LOURDES
Other - Last Name:LOZADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:9040 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-967-4108
Mailing Address - Fax:
Practice Address - Street 1:BLDG 9059 WTB A CO
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-967-4108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT44461163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty