Provider Demographics
NPI:1215216247
Name:MUNDELL, KARLA
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:
Last Name:MUNDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 THORNBUSH TRCE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4745
Mailing Address - Country:US
Mailing Address - Phone:678-558-6691
Mailing Address - Fax:
Practice Address - Street 1:420 THORNBUSH TRCE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4745
Practice Address - Country:US
Practice Address - Phone:678-558-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056628164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse