Provider Demographics
NPI:1942392428
Name:KUNZ, GARY J (MSN)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:J
Last Name:KUNZ
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15821 BUCK LANE
Mailing Address - Street 2:
Mailing Address - City:MISHICOT
Mailing Address - State:WI
Mailing Address - Zip Code:54228
Mailing Address - Country:US
Mailing Address - Phone:920-755-2838
Mailing Address - Fax:
Practice Address - Street 1:1205 NORTH AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:WI
Practice Address - Zip Code:53015
Practice Address - Country:US
Practice Address - Phone:920-693-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR116852-7363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily