Provider Demographics
NPI:1992382683
Name:MUND, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:MUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18568 FORTY SIX PKWY STE 1001
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6878
Mailing Address - Country:US
Mailing Address - Phone:830-438-9300
Mailing Address - Fax:
Practice Address - Street 1:18568 TEXAS 46
Practice Address - Street 2:SUITE #1001
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070
Practice Address - Country:US
Practice Address - Phone:830-438-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1033072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily