Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LG0600X | Nurse Practitioner - Gerontology | 95003037 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95003037 | CA |
NPI | 1053789297 |
---|---|
Provider Name | Ms. Julie Kunath |
First Address | El Centro, CA 92243-4200 |
Second Address | El Centro, CA 92243-4200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2015 |
Last Update Date | 06/04/2018 |