Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704227174 | MI |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 4704227174 | MI |
NPI | 1457586968 |
---|---|
Provider Name | Mrs. Patti Lynn Kunkel |
First Address | Lasalle, ONTARIO N9J3A8 |
Second Address | Detroit, MI 48202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2009 |
Last Update Date | 17/02/2021 |