Provider Demographics
NPI:1316372881
Name:KUNCELMAN, REGINA S (CRNP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:S
Last Name:KUNCELMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:REGINA
Other - Middle Name:S
Other - Last Name:PARONISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 MUNICIPAL RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:PA
Mailing Address - Zip Code:16646-6811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1020 MUNICIPAL RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:PA
Practice Address - Zip Code:16646-6811
Practice Address - Country:US
Practice Address - Phone:814-248-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN596128163W00000X
PASP013201363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103076079-0001Medicaid