| Doctor Name: | LISA KUNKLE |
| NPI Number: | 1568494797 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | MP000802 |
| Business Practice Address: | 107 E Mantua Ave Wenonah, NJ - 080901950 |
| Business Phone Number: | 8564686868 |
| Business Fax Number: | 8564641855 |
| Mailing Address: | 622 Kings Hwy, MICKLETON |
| State: | NJ |
| Postal Code: | 080561404 |
| Phone Number: | 8563325613 |
| Fax Number: | |
| NPI Enumeration Date: | 07/07/2006 |
| NPI Last Update Date: | 11/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MP000802 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |