Provider Demographics
NPI:1255834941
Name:KUNISCH, ELLE CRUZ (CRNP)
Entity Type:Individual
Prefix:
First Name:ELLE
Middle Name:CRUZ
Last Name:KUNISCH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELVIRA
Other - Middle Name:G
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:177 GHANER DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1169
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1850 E PARK AVE STE 302
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6706
Practice Address - Country:US
Practice Address - Phone:814-278-4680
Practice Address - Fax:814-235-1523
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020893363LG0600X, 363LP2300X, 363LA2200X
TXAP136854363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care