Provider Demographics
NPI:1023627445
Name:PUNKAY, NATALIE REBECCA
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:REBECCA
Last Name:PUNKAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 TERRACE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440-1107
Mailing Address - Country:US
Mailing Address - Phone:800-644-2434
Mailing Address - Fax:
Practice Address - Street 1:715 TERRACE ST STE 201
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1107
Practice Address - Country:US
Practice Address - Phone:800-644-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382227805Medicaid