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General NPI Number Information
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NPI Number | 1407977192
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Entity Type | Individual
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Provider Name | AYNESSA D. MONDLAK RN, MSN, C-FNP
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/28/2009
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Provider Practice Location Address
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Address Line | 2900 1ST AVE
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City | HUNTINGTON
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State | WV
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Zip | 25702-1241
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Country | US
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Telephone | 304-526-1872
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Fax | 304-526-1809
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Provider Business Mailing Address
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Address Line | 2900 1ST AVE
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City | HUNTINGTON
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State | WV
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Zip | 25702-1241
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Country | US
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Telephone | 304-526-1872
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Fax | 304-526-1809
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 49147
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License Number State | WV
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