Provider Demographics
NPI:1083805618
Name:MUNDY, RENEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:MUNDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ORLEANS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1767
Mailing Address - Country:US
Mailing Address - Phone:517-278-2129
Mailing Address - Fax:517-279-8172
Practice Address - Street 1:200 ORLEANS BLVD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1767
Practice Address - Country:US
Practice Address - Phone:517-278-2129
Practice Address - Fax:517-279-8172
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704206687163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health