Provider Demographics
NPI:1962266700
Name:KINNETZ, JERRY
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:KINNETZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-1362
Mailing Address - Country:US
Mailing Address - Phone:319-277-4000
Mailing Address - Fax:
Practice Address - Street 1:2009 CENTER ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-1362
Practice Address - Country:US
Practice Address - Phone:319-277-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications