Provider Demographics
NPI:1376779090
Name:KUNKLE, MICHELLE LYNNE (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNNE
Last Name:KUNKLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E SAN MARNAN DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5837
Mailing Address - Country:US
Mailing Address - Phone:319-235-3158
Mailing Address - Fax:319-235-9836
Practice Address - Street 1:305 E SAN MARNAN DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5837
Practice Address - Country:US
Practice Address - Phone:319-235-3158
Practice Address - Fax:319-235-9836
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA099381363LF0000X
NDR38041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA099381OtherLICENSE
IAI14210031Medicare PIN