Provider Demographics
NPI:1184793887
Name:KUNZ, MAUREEN LESLIE (PA-C)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:LESLIE
Last Name:KUNZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 COMMONS LOOP
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1904
Mailing Address - Country:US
Mailing Address - Phone:406-756-7555
Mailing Address - Fax:406-756-7517
Practice Address - Street 1:175 COMMONS LOOP
Practice Address - Street 2:SUITE 300
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1904
Practice Address - Country:US
Practice Address - Phone:406-756-7555
Practice Address - Fax:406-756-7517
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT51991363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTS544606Medicare UPIN