Provider Demographics
NPI:1881239127
Name:KUNSMAN, JENNA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:KUNSMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:WEIDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:940 N NEW ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-2756
Mailing Address - Country:US
Mailing Address - Phone:610-861-9804
Mailing Address - Fax:610-866-4359
Practice Address - Street 1:940 N NEW ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-2756
Practice Address - Country:US
Practice Address - Phone:610-861-9804
Practice Address - Fax:610-861-9804
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1316986763OtherCOMMERCIAL. CAPITAL, AETNA