Provider Demographics
NPI:1609519818
Name:KUNTZ, JUSTINE M (LPN)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:M
Last Name:KUNTZ
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 1:274 STISSING RD
Mailing Address - Street 2:
Mailing Address - City:STANFORDVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12581-5743
Mailing Address - Country:US
Mailing Address - Phone:845-492-0301
Mailing Address - Fax:
Practice Address - Street 1:274 STISSING RD
Practice Address - Street 2:
Practice Address - City:STANFORDVILLE
Practice Address - State:NY
Practice Address - Zip Code:12581-5743
Practice Address - Country:US
Practice Address - Phone:845-492-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338591164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse