Provider Demographics
NPI:1346874146
Name:KUNS, DEANNA LORRAINE
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LORRAINE
Last Name:KUNS
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 1:1487 EVENING SONG AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4466
Mailing Address - Country:US
Mailing Address - Phone:702-300-9050
Mailing Address - Fax:
Practice Address - Street 1:2375 E TROPICANA AVE # 144
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6564
Practice Address - Country:US
Practice Address - Phone:702-827-4524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1225677487Medicaid