Provider Demographics
NPI:1952181596
Name:MUNGOVAN, ILZE EMILY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ILZE
Middle Name:EMILY
Last Name:MUNGOVAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ILZE
Other - Middle Name:EMILY
Other - Last Name:STANKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:159 GREENMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:159 GREENMEADOW DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-4183
Practice Address - Country:US
Practice Address - Phone:631-662-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily