Individual
LISA KUNKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
107 E MANTUA AVE, WENONAH, NJ 08090-1950
(856) 468-6868
(856) 464-1855
Mailing address
622 KINGS HWY, MICKLETON, NJ 08056-1404
(856) 332-5613
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MP000802
NJ
Other
Enumeration date
07/07/2006
Last updated
11/23/2010
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