Provider Demographics
NPI:1730334483
Name:KUNASZUK, ROSE MARIE ECKERT (DRNP, CNM)
Entity type:Individual
Prefix:
First Name:ROSE MARIE
Middle Name:ECKERT
Last Name:KUNASZUK
Suffix:
Gender:F
Credentials:DRNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1635
Mailing Address - Country:US
Mailing Address - Phone:610-825-8169
Mailing Address - Fax:610-825-8169
Practice Address - Street 1:1075 COLWELL LN
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-3206
Practice Address - Country:US
Practice Address - Phone:610-828-9683
Practice Address - Fax:484-344-5551
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008408L367A00000X
NJ25ME00031001367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA597586OtherMEDICARE GROUP
PA852813OtherMEDICARE
PA852813OtherMEDICARE