Provider Demographics
NPI:1639652845
Name:MUNDERLOH, LINDA FAYE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:FAYE
Last Name:MUNDERLOH
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:BANCROFT
Mailing Address - State:NE
Mailing Address - Zip Code:68004-0129
Mailing Address - Country:US
Mailing Address - Phone:402-648-3336
Mailing Address - Fax:402-648-3338
Practice Address - Street 1:708 MAIN ST
Practice Address - Street 2:
Practice Address - City:BANCROFT
Practice Address - State:NE
Practice Address - Zip Code:68004-3014
Practice Address - Country:US
Practice Address - Phone:402-648-3336
Practice Address - Fax:402-648-3338
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10653164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse