Active NPI
Myra Renae Kuntz, LMP
- Specialist
- Snohomish, WA
National Provider Identifier
1780801795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA00015610
- Practice address
- 15209 3 Lakes Rd
Snohomish, WA 98290-4614 - Phone
- (360) 568-0813
- NPI assigned
- Apr 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA00015610 | WA | Primary |
Addresses
Primary practice location
15209 3 Lakes Rd
Snohomish, WA 98290-4614
Mailing address
12506 18TH St NE
Suite 4
Lake Stevens, WA 98258
Phone (425) 334-9664
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00015610 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780801795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12506 18TH ST NE",
"address_2": "SUITE 4",
"city": "LAKE STEVENS",
"state": "WA",
"postal_code": "98258",
"telephone_number": "425-334-9664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15209 3 LAKES RD",
"city": "SNOHOMISH",
"state": "WA",
"postal_code": "982904614",
"telephone_number": "360-568-0813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUNTZ",
"first_name": "MYRA",
"middle_name": "RENAE",
"name_prefix": "Mrs.",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA00015610",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Snohomish, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.