Provider Demographics
NPI:1497282164
Name:KUNKEL, CHRISTINE (CPM)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 SHADY FOXTAIL CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-2541
Mailing Address - Country:US
Mailing Address - Phone:202-702-9661
Mailing Address - Fax:
Practice Address - Street 1:4041 SHADY FOXTAIL CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-2541
Practice Address - Country:US
Practice Address - Phone:202-702-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDEM00036176B00000X
374J00000X, 176B00000X
VA0129000165176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty