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General NPI Number Information
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NPI Number | 1598636805
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Entity Type | Individual
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Provider Name | NICOLE ELIZABETH MUNDIE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 350 LORTON AVE
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City | BURLINGAME
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State | CA
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Zip | 94010-4104
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Country | US
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Telephone | 650-677-1092
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Fax |
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Provider Business Mailing Address
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Address Line | 360 MCGAFFIGAN MILL RD
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City | BOULDER CREEK
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State | CA
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Zip | 95006-9016
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Country | US
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Telephone | 224-659-2905
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95032427
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License Number State | CA
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