Provider Demographics
NPI:1669674495
Name:KUNATH, ROBERTA NOLAN (VN)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:NOLAN
Last Name:KUNATH
Suffix:
Gender:F
Credentials:VN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15962 MESTEA RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-1352
Mailing Address - Country:US
Mailing Address - Phone:760-955-1677
Mailing Address - Fax:
Practice Address - Street 1:15962 MESETA RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1352
Practice Address - Country:US
Practice Address - Phone:760-955-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN80101164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse