MEDICARE: JENNIFER MUNDT ND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	09-1136	AZ

General Provider Information

NPI Number	:	1841525375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MUNDT ND

Provider Business Mailing Address
First Line	:	6020 N 16TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-1802
Country	:	US
Telephone Number	:	602-343-6355
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 N 16TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-1802
Country	:	US
Telephone Number	:	602-343-6355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2009
Last Update Date	:	03/30/2016

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