Individual
MRS. AYNESSA D. MONDLAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, MSN, C-FNP
Contact information
Practice address
2900 1ST AVE, HUNTINGTON, WV 25702-1241
(304) 526-1872
(304) 526-1809
Mailing address
2900 1ST AVE, HUNTINGTON, WV 25702-1241
(304) 526-1872
(304) 526-1809
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
49147
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000272703
OH UNISON
OH
01
—
1073953
WV COMPENSATION
WV
05
—
3810012715
—
WV
01
—
613154600
FEDERAL BLACK LUNG/FECA
WV
Enumeration date
04/02/2007
Last updated
08/28/2009
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