Provider Demographics
NPI:1699949891
Name:KUNKEL, CHERRY P (RN)
Entity type:Individual
Prefix:
First Name:CHERRY
Middle Name:P
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 W SCHROEDER DR STE 185
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1494
Mailing Address - Country:US
Mailing Address - Phone:414-586-0222
Mailing Address - Fax:414-586-0236
Practice Address - Street 1:4555 W SCHROEDER DR STE 185
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-1494
Practice Address - Country:US
Practice Address - Phone:414-586-0222
Practice Address - Fax:414-586-0236
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126285-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42027500Medicaid