Provider Demographics
NPI:1932561883
Name:MUNDY, ANITA (RN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:MUNDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 RIVER RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-6563
Mailing Address - Country:US
Mailing Address - Phone:716-693-9961
Mailing Address - Fax:716-693-4402
Practice Address - Street 1:624 RIVER RD
Practice Address - Street 2:SUITE 8
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6563
Practice Address - Country:US
Practice Address - Phone:716-693-9961
Practice Address - Fax:716-693-4402
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY446005-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse