Provider Demographics
NPI:1962239376
Name:4 INTEGRATED HEALTH LLC
Entity type:Organization
Organization Name:4 INTEGRATED HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNKLE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:309-291-0469
Mailing Address - Street 1:825 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1569
Mailing Address - Country:US
Mailing Address - Phone:309-291-0469
Mailing Address - Fax:309-291-0467
Practice Address - Street 1:825 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1569
Practice Address - Country:US
Practice Address - Phone:309-291-0469
Practice Address - Fax:309-291-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty