Provider Demographics
NPI:1578787131
Name:MUNGUIA, WENDI JEAN (DT)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:JEAN
Last Name:MUNGUIA
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1518
Mailing Address - Country:US
Mailing Address - Phone:618-696-2288
Mailing Address - Fax:618-654-1833
Practice Address - Street 1:600 9TH ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1518
Practice Address - Country:US
Practice Address - Phone:618-696-2288
Practice Address - Fax:618-654-1833
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor