Provider Demographics
NPI:1801808506
Name:KUNA, CHRISTIE MARIE (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:MARIE
Last Name:KUNA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:LIBERATORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, MSN, RN, BSN
Mailing Address - Street 1:632 BROADWAY PH 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2614
Mailing Address - Country:US
Mailing Address - Phone:347-294-3414
Mailing Address - Fax:
Practice Address - Street 1:632 BROADWAY PH 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2614
Practice Address - Country:US
Practice Address - Phone:347-294-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3349531207Q00000X
VA0017139005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06695OtherMEDICARE GROUP PTAN
NY01444917Medicaid
VAC05700OtherGROUP PTAN
VAC09633OtherGROUP PTAN
VAC06778OtherGROUP PTAN