Provider Demographics
NPI:1700426962
Name:KUNTZ, LAKEN JOEL (NP-C)
Entity Type:Individual
Prefix:
First Name:LAKEN
Middle Name:JOEL
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 NORTHERN PIKE STE 830
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2809
Mailing Address - Country:US
Mailing Address - Phone:814-418-1999
Mailing Address - Fax:
Practice Address - Street 1:3824 NORTHERN PIKE STE 830
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2172
Practice Address - Country:US
Practice Address - Phone:412-457-0427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021371363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology