Provider Demographics
NPI:1063710937
Name:KUNNEN, BARBARA JANE (MS, RN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JANE
Last Name:KUNNEN
Suffix:
Gender:F
Credentials:MS, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E CEDAR ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2057
Mailing Address - Country:US
Mailing Address - Phone:574-335-8700
Mailing Address - Fax:574-335-0741
Practice Address - Street 1:114 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOURBON
Practice Address - State:IN
Practice Address - Zip Code:46504-1623
Practice Address - Country:US
Practice Address - Phone:574-335-7850
Practice Address - Fax:574-335-0755
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003229A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000701100OtherBCBS -- BOURBON FAM
IN201015340Medicaid
IN000000932418OtherBCBS LSC
INP01574992OtherRR MEDICARE BOURBON
IN000000901480OtherBCBS SJHC
INP01574992OtherRR MEDICARE BOURBON
INM161595002Medicare PIN
INM400042082Medicare PIN
INP01574992OtherRR MEDICARE BOURBON