Provider Demographics
NPI:1376867770
Name:KUNKLER, LYNDSIA (LPN)
Entity Type:Individual
Prefix:
First Name:LYNDSIA
Middle Name:
Last Name:KUNKLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 N BUCKEYE ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-1508
Mailing Address - Country:US
Mailing Address - Phone:419-953-7984
Mailing Address - Fax:567-890-5017
Practice Address - Street 1:519 N BUCKEYE ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1508
Practice Address - Country:US
Practice Address - Phone:419-953-7984
Practice Address - Fax:567-890-5017
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.138787164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3040695Medicaid