Provider Demographics
NPI:1598726572
Name:MUNDT, NOELLE C (NP)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:C
Last Name:MUNDT
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 1:8101 BIRCHWOOD CT
Mailing Address - Street 2:SUITE S
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2930
Mailing Address - Country:US
Mailing Address - Phone:515-471-9720
Mailing Address - Fax:515-471-9725
Practice Address - Street 1:840 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2304
Practice Address - Country:US
Practice Address - Phone:515-265-4211
Practice Address - Fax:515-309-5993
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA090681363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0481176Medicaid
IAI18347Medicare PIN
IAQ72366Medicare UPIN
IA0481176Medicaid