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General NPI Number Information
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NPI Number | 1457948366
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Entity Type | Individual
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Provider Name | CARLA MUNDT
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Gender | Female
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Dates
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Enumeration Date | 12/26/2020
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 1925 W ORANGE GROVE RD STE 105
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City | TUCSON
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State | AZ
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Zip | 85704-1150
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Country | US
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Telephone | 520-526-9699
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Fax |
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Provider Business Mailing Address
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Address Line | 6912 S QUENTIN ST STE 50
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City | CENTENNIAL
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State | CO
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Zip | 80112-4531
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Country | US
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Telephone | 720-282-2377
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 249343
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 249343
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License Number State | AZ
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