Provider Demographics
NPI:1811219249
Name:MULONDO, JACQUELINE (CNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MULONDO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6854 GREGORY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1786
Mailing Address - Country:US
Mailing Address - Phone:513-255-6839
Mailing Address - Fax:
Practice Address - Street 1:6854 GREGORY CREEK LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1786
Practice Address - Country:US
Practice Address - Phone:513-255-6839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.270976-COA 1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health