Provider Demographics
NPI:1396407664
Name:KUNSONA, IVY
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:KUNSONA
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 1:4434 68TH PL APT B5
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2021
Mailing Address - Country:US
Mailing Address - Phone:240-610-7050
Mailing Address - Fax:
Practice Address - Street 1:4434 68TH PL APT B5
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2021
Practice Address - Country:US
Practice Address - Phone:240-610-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide