Provider Demographics
NPI:1508129834
Name:KUNZ, MEGHAN (MSN, RN)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:KUNZ
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W 100 S STE 108
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4551
Mailing Address - Country:US
Mailing Address - Phone:435-881-5703
Mailing Address - Fax:
Practice Address - Street 1:95 W 100 S STE 108
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4551
Practice Address - Country:US
Practice Address - Phone:435-881-5703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT323493-3102163W00000X
UT323493-4405363LP0808X
UT323493-8900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse