Provider Demographics
NPI:1952411134
Name:KUNBERGER, CARRIE L (PAC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:KUNBERGER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13820 N 51ST AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306
Mailing Address - Country:US
Mailing Address - Phone:602-938-1706
Mailing Address - Fax:602-938-5104
Practice Address - Street 1:13820 N 51ST AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-938-1706
Practice Address - Fax:602-938-5104
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q34077Medicare UPIN
AZ100494Medicare ID - Type Unspecified