Provider Demographics
NPI:1407077084
Name:MUNGIN, DANIELLE EINEQUE
Entity Type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:EINEQUE
Last Name:MUNGIN
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 1:449 BARCLAY SQUARE WEST APT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224
Mailing Address - Country:US
Mailing Address - Phone:614-732-2120
Mailing Address - Fax:
Practice Address - Street 1:449 BARCLAY SQUARE WEST APT A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224
Practice Address - Country:US
Practice Address - Phone:614-732-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2648737Medicaid