Provider Demographics
NPI:1306271556
Name:MONDEAU, KARA (PA)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:MONDEAU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:602 BEECH ST
Mailing Address - Street 2:SUITE 2240
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-1466
Mailing Address - Country:US
Mailing Address - Phone:989-802-8730
Mailing Address - Fax:989-802-5034
Practice Address - Street 1:602 BEECH ST
Practice Address - Street 2:SUITE 2240
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1466
Practice Address - Country:US
Practice Address - Phone:989-802-8730
Practice Address - Fax:989-802-5034
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant