Provider Demographics
NPI:1538313457
Name:MUNDELL, GINA MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:MUNDELL
Suffix:
Gender:F
Credentials:FNP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2920 N CASCADE AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6262
Mailing Address - Country:US
Mailing Address - Phone:719-636-1201
Mailing Address - Fax:719-955-0986
Practice Address - Street 1:2920 N CASCADE AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6262
Practice Address - Country:US
Practice Address - Phone:719-636-1201
Practice Address - Fax:719-955-0986
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0005322-NP207P00000X, 208M00000X, 363L00000X
CO125863363LF0000X
COAPN.0005322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69171751Medicaid
CO69171751Medicaid