Provider Demographics
NPI:1023281334
Name:KUNKEL, TRACEY (RN)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:SAMPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4209 NEWGATE AVE
Mailing Address - Street 2:USNS COMFORT
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-6416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4209 NEWGATE AVE
Practice Address - Street 2:USNS COMFORT
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6416
Practice Address - Country:US
Practice Address - Phone:410-631-7461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN33592L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse