Provider Demographics
NPI:1629250279
Name:KUNIK, JENNI KAYE (PA)
Entity Type:Individual
Prefix:
First Name:JENNI
Middle Name:KAYE
Last Name:KUNIK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9070
Mailing Address - Country:US
Mailing Address - Phone:989-772-6700
Mailing Address - Fax:989-772-6807
Practice Address - Street 1:1221 SOUTH DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3257
Practice Address - Country:US
Practice Address - Phone:989-772-6700
Practice Address - Fax:989-772-6807
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005069363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601005069OtherMI LICENSE