Provider Demographics
NPI:1366824757
Name:KUNISCH, JILL ANNE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANNE
Last Name:KUNISCH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
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Mailing Address - Street 1:5855 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2269
Mailing Address - Country:US
Mailing Address - Phone:419-824-7451
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:2865 N REYNOLDS RD
Practice Address - Street 2:SUITE 160
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2068
Practice Address - Country:US
Practice Address - Phone:419-578-4260
Practice Address - Fax:419-578-5630
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAG0615058363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology