Provider Demographics
NPI:1710682794
Name:KUNZ, ANDREA JOY
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JOY
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 1:8921 TEWSBURY GATE
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-1125
Mailing Address - Country:US
Mailing Address - Phone:763-772-7006
Mailing Address - Fax:
Practice Address - Street 1:8921 TEWSBURY GATE
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-1125
Practice Address - Country:US
Practice Address - Phone:763-772-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61409538163WC1500X
MN2491023163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health