Provider Demographics
NPI:1326763822
Name:KUNTZ, KIM LYNN
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:LYNN
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 1:5405 371ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:DALBO
Mailing Address - State:MN
Mailing Address - Zip Code:55017-8301
Mailing Address - Country:US
Mailing Address - Phone:763-689-6524
Mailing Address - Fax:
Practice Address - Street 1:5405 371ST AVE NW
Practice Address - Street 2:
Practice Address - City:DALBO
Practice Address - State:MN
Practice Address - Zip Code:55017-8301
Practice Address - Country:US
Practice Address - Phone:763-689-6524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program