Provider Demographics
NPI:1841525375
Name:MUNDT, JENNIFER (ND)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MUNDT
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-1802
Mailing Address - Country:US
Mailing Address - Phone:602-343-6355
Mailing Address - Fax:
Practice Address - Street 1:6020 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-1802
Practice Address - Country:US
Practice Address - Phone:602-343-6355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-17
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09-1136175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath