Provider Demographics
NPI:1609995257
Name:MUNDT, LORI JO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JO
Last Name:MUNDT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 FAIR LN
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2592
Mailing Address - Country:US
Mailing Address - Phone:712-269-9476
Mailing Address - Fax:
Practice Address - Street 1:2718 FAIR LN
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2592
Practice Address - Country:US
Practice Address - Phone:712-269-9476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP34666164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse