Provider Demographics
NPI:1497841852
Name:MUNDAY, LOUANN (NP)
Entity Type:Individual
Prefix:
First Name:LOUANN
Middle Name:
Last Name:MUNDAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2106
Mailing Address - Country:US
Mailing Address - Phone:304-344-3298
Mailing Address - Fax:304-346-4349
Practice Address - Street 1:511 MORRIS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1326
Practice Address - Country:US
Practice Address - Phone:304-341-0511
Practice Address - Fax:304-341-0197
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV257008-22363L00000X
WVF0796189363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7102249-000Medicaid
WVS69884Medicare UPIN
WV7102249-000Medicaid