Provider Demographics
NPI:1881614063
Name:KUNS, MARY ROSE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ROSE
Last Name:KUNS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W MCPHERSON HWY
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410-1132
Mailing Address - Country:US
Mailing Address - Phone:419-547-8555
Mailing Address - Fax:419-547-9119
Practice Address - Street 1:455 W MCPHERSON HWY
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-1132
Practice Address - Country:US
Practice Address - Phone:419-547-8555
Practice Address - Fax:419-547-9119
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP03466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2333184Medicaid
OHP24460Medicare UPIN
OH2333184Medicaid