Provider Demographics
NPI:1558608828
Name:KUNZ, MARY Y
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:Y
Last Name:KUNZ
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 1:6550 N HIGHWAY 151 LOT 63
Mailing Address - Street 2:
Mailing Address - City:BEAVERDAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916
Mailing Address - Country:US
Mailing Address - Phone:608-220-1141
Mailing Address - Fax:
Practice Address - Street 1:6550 N HIGHWAY 151 LOT 63
Practice Address - Street 2:
Practice Address - City:BEAVERDAM
Practice Address - State:WI
Practice Address - Zip Code:53916
Practice Address - Country:US
Practice Address - Phone:608-220-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28849-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse