Provider Demographics
NPI:1659746832
Name:KUNZ, TAMMY
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
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 1:1164 MADISON ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-7861
Mailing Address - Country:US
Mailing Address - Phone:971-701-3008
Mailing Address - Fax:503-585-0491
Practice Address - Street 1:1164 MADISON ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-7861
Practice Address - Country:US
Practice Address - Phone:971-701-3008
Practice Address - Fax:503-585-0491
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist