Provider Demographics
NPI:1811510506
Name:WUNSCH, KRISTA (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:WUNSCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 GRAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-3676
Mailing Address - Country:US
Mailing Address - Phone:847-249-1733
Mailing Address - Fax:847-782-4515
Practice Address - Street 1:1616 GRAND AVE STE A
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-3676
Practice Address - Country:US
Practice Address - Phone:847-249-1733
Practice Address - Fax:847-782-4515
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085008391363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant