Provider Demographics
NPI:1760729578
Name:KUNTZMAN, JENNYFER LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JENNYFER
Middle Name:LYNN
Last Name:KUNTZMAN
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 1:879 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-2835
Mailing Address - Country:US
Mailing Address - Phone:330-428-3805
Mailing Address - Fax:
Practice Address - Street 1:879 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2835
Practice Address - Country:US
Practice Address - Phone:330-428-3805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151518164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse