Provider Demographics
NPI:1598874653
Name:MUNGER, LOUISA LINSLEY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LOUISA
Middle Name:LINSLEY
Last Name:MUNGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BON AIR RD
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1123
Mailing Address - Country:US
Mailing Address - Phone:415-927-5300
Mailing Address - Fax:415-927-6860
Practice Address - Street 1:7100 REDWOOD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4110
Practice Address - Country:US
Practice Address - Phone:415-927-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17524363A00000X
CA17524363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17524OtherLICENSE
CAMH0157001OtherDEA
CAPA17524OtherLICENSE