Provider Demographics
NPI:1912381443
Name:MUNDT, CARMEN (ARNP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:MUNDT
Suffix:
Gender:F
Credentials:ARNP
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 2758
Mailing Address - Street 2:4150 KIMBALL AVENUE
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:319-233-1630
Practice Address - Street 1:1753 W RIDGEWAY AVE
Practice Address - Street 2:STE 107
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4544
Practice Address - Country:US
Practice Address - Phone:319-833-5907
Practice Address - Fax:319-833-5908
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH091730363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner