Provider Demographics
NPI:1114300316
Name:MUNDA, MATTHEW (CRNP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MUNDA
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 NW 56TH ST
Mailing Address - Street 2:SUITE 612
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4479
Mailing Address - Country:US
Mailing Address - Phone:405-601-8810
Mailing Address - Fax:877-795-8060
Practice Address - Street 1:13921 N MERIDIAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1106
Practice Address - Country:US
Practice Address - Phone:405-752-9600
Practice Address - Fax:405-752-9650
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0106050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200701860AMedicaid