Provider Demographics
NPI:1285757963
Name:GUNKEL, SONJA MAE (OWNER)
Entity type:Individual
Prefix:MS
First Name:SONJA
Middle Name:MAE
Last Name:GUNKEL
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43247 227TH ST
Mailing Address - Street 2:
Mailing Address - City:HENNING
Mailing Address - State:MN
Mailing Address - Zip Code:56551-9442
Mailing Address - Country:US
Mailing Address - Phone:218-583-4432
Mailing Address - Fax:
Practice Address - Street 1:43247 227TH ST
Practice Address - Street 2:
Practice Address - City:HENNING
Practice Address - State:MN
Practice Address - Zip Code:56551-9442
Practice Address - Country:US
Practice Address - Phone:218-583-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225430-2171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor