Provider Demographics
NPI:1144974262
Name:KUNZE, TREVOR JAMES
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:JAMES
Last Name:KUNZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 CHAPLINE ST APT 711
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3862
Mailing Address - Country:US
Mailing Address - Phone:304-830-6591
Mailing Address - Fax:
Practice Address - Street 1:2230 CHAPLINE ST APT 711
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3862
Practice Address - Country:US
Practice Address - Phone:304-830-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1821206228Medicaid
WV125553494Medicaid
WV1356607394Medicaid