Provider Demographics
NPI:1255607677
Name:KUENY, THERESA G (PA-C)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:G
Last Name:KUENY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:500 EVERGREEN DRIVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1017
Mailing Address - Country:US
Mailing Address - Phone:484-785-3376
Mailing Address - Fax:610-358-6913
Practice Address - Street 1:500 EVERGREEN DR
Practice Address - Street 2:SUITE 20
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1017
Practice Address - Country:US
Practice Address - Phone:484-785-3376
Practice Address - Fax:610-358-6913
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA055391363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1255607677Medicaid