Provider Demographics
NPI:1073325619
Name:DUNDAS MONGRUE, AUDREY SWEETIE
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:SWEETIE
Last Name:DUNDAS MONGRUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 JAY WAY
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7953
Mailing Address - Country:US
Mailing Address - Phone:651-900-0861
Mailing Address - Fax:
Practice Address - Street 1:5701 SHINGLE CREEK PKWY STE 250Q
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2382
Practice Address - Country:US
Practice Address - Phone:763-898-9308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA472490500374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide