MEDICARE: CAMILLE L MUNDH FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	95023281	CA

General Provider Information

NPI Number	:	1083322168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE L MUNDH FNP-C

Provider Business Mailing Address
First Line	:	3302 ARBOR WAY
Second Line	:
City	:	LIVE OAK
State	:	CA
Zip	:	95953-9435
Country	:	US
Telephone Number	:	530-617-2071
Fax Number	:

Provider Business Practice Location Address
First Line	:	9792 LIVE OAK BLVD STE E
Second Line	:
City	:	LIVE OAK
State	:	CA
Zip	:	95953-2381
Country	:	US
Telephone Number	:	530-701-3131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	11/08/2022

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Directions to “ CAMILLE L MUNDH FNP-C” Practice Location

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