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General NPI Number Information
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NPI Number | 1407661580
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Entity Type | Individual
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Provider Name | ALICE G MUKUNJURA APRN, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 1431 OPUS PL STE 110
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1164
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Country | US
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Telephone | 888-279-0002
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Fax |
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Provider Business Mailing Address
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Address Line | 2456 HART DR SW
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City | ROCHESTER
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State | MN
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Zip | 55902-1564
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Country | US
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Telephone | 507-319-0291
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12459
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License Number State | MN
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