Healthcare Provider Details

I. General information

NPI: 1881114536
Provider Name (Legal Business Name): JULIE CRISTINA EASTERDAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE CRISTINA MUNDT RN

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13180 E COLOSSAL CAVE RD STE 150
VAIL AZ
85641-8757
US

IV. Provider business mailing address

17176 S MESA SHADOWS DR
VAIL AZ
85641-2470
US

V. Phone/Fax

Practice location:
  • Phone: 520-762-1557
  • Fax: 520-762-8019
Mailing address:
  • Phone: 520-400-8246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10153
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: