Provider Demographics
NPI:1104036904
Name:MUNOZ, NATALIE GRACE (LPN)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:GRACE
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 ALLAN ST.
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103
Mailing Address - Country:US
Mailing Address - Phone:402-837-5381
Mailing Address - Fax:
Practice Address - Street 1:100 INDIAN HILLS DR.
Practice Address - Street 2:
Practice Address - City:MACY
Practice Address - State:NE
Practice Address - Zip Code:68039
Practice Address - Country:US
Practice Address - Phone:402-837-5381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP47501164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse