Provider Demographics
NPI:1356053391
Name:MUNDORF, SHAUNA (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:MUNDORF
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1913
Mailing Address - Country:US
Mailing Address - Phone:413-231-0306
Mailing Address - Fax:
Practice Address - Street 1:387 E DUNSTABLE RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-4223
Practice Address - Country:US
Practice Address - Phone:603-417-6608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH083742-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily