Provider Demographics
NPI:1881754471
Name:MUNDENAR, EILEEN O (PA)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:O
Last Name:MUNDENAR
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Gender:F
Credentials:PA
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Mailing Address - Street 1:6200 SHINGLE CREEK PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2128
Mailing Address - Country:US
Mailing Address - Phone:763-561-5349
Mailing Address - Fax:763-561-7792
Practice Address - Street 1:6200 SHINGLE CREEK PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2128
Practice Address - Country:US
Practice Address - Phone:763-561-5349
Practice Address - Fax:763-561-7792
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-03-30
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Provider Licenses
StateLicense IDTaxonomies
MN10221363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical