Provider Demographics
NPI:1366205072
Name:KUNKEL, JENNIFER L (CNA)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:L
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 FLAMBEAU AVE UPPR
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555-1013
Mailing Address - Country:US
Mailing Address - Phone:715-820-0459
Mailing Address - Fax:
Practice Address - Street 1:N9671 DEER LAKE LN
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555-7761
Practice Address - Country:US
Practice Address - Phone:715-339-6706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI321478374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide