Provider Demographics
NPI:1033477252
Name:MUNGER, KATHRIN CLAIRE (LAC)
Entity Type:Individual
Prefix:
First Name:KATHRIN
Middle Name:CLAIRE
Last Name:MUNGER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4336
Mailing Address - Street 2:
Mailing Address - City:TUBAC
Mailing Address - State:AZ
Mailing Address - Zip Code:85646-4336
Mailing Address - Country:US
Mailing Address - Phone:520-403-7347
Mailing Address - Fax:
Practice Address - Street 1:6 CAMINO OTERO
Practice Address - Street 2:
Practice Address - City:TUBAC
Practice Address - State:AZ
Practice Address - Zip Code:85646-4336
Practice Address - Country:US
Practice Address - Phone:520-403-7347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0135171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist