Provider Demographics
NPI:1720742083
Name:MUNDHENKE, CAROLINE A (ACNP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:A
Last Name:MUNDHENKE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:STANCHIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST # MS 400S
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-960-7600
Mailing Address - Fax:
Practice Address - Street 1:4400 BROADWAY BLVD STE 520
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3342
Practice Address - Country:US
Practice Address - Phone:816-960-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021042605363LA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health