Provider Demographics
NPI:1063102705
Name:KUNZLER, KATRINA ELIZABETH
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:ELIZABETH
Last Name:KUNZLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 E 3050 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4228
Mailing Address - Country:US
Mailing Address - Phone:801-793-0283
Mailing Address - Fax:
Practice Address - Street 1:491 E 3050 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4228
Practice Address - Country:US
Practice Address - Phone:801-793-0283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program