Provider Demographics
NPI:1861844789
Name:JUNGE, MYLA (FNP, RN)
Entity Type:Individual
Prefix:
First Name:MYLA
Middle Name:
Last Name:JUNGE
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 TACOMA ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2823
Mailing Address - Country:US
Mailing Address - Phone:415-385-2405
Mailing Address - Fax:
Practice Address - Street 1:50 BEALE ST
Practice Address - Street 2:12TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-1813
Practice Address - Country:US
Practice Address - Phone:415-547-7818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-02
Last Update Date:2021-03-16
Deactivation Date:2019-10-01
Deactivation Code:
Reactivation Date:2020-10-28
Provider Licenses
StateLicense IDTaxonomies
CA95012199363LF0000X
CA796831163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse