Provider Demographics
NPI:1699958843
Name:KUNZ, JACQUELINE L (RNC, NNP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:L
Last Name:KUNZ
Suffix:
Gender:F
Credentials:RNC, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9515 HOLY CROSS LN
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-3618
Mailing Address - Country:US
Mailing Address - Phone:618-526-4511
Mailing Address - Fax:618-526-4537
Practice Address - Street 1:9515 HOLY CROSS LN
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-3618
Practice Address - Country:US
Practice Address - Phone:618-526-4511
Practice Address - Fax:618-526-4537
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006861363LN0000X, 363L00000X
MO109569363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal