Basic Information
Provider Information
NPI: 1275158636
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHATTARAI
FirstName: MUNA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MNS, MA
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 25 KESSEL CT STE 105
Address2:  
City: MADISON
State: WI
PostalCode: 537116227
CountryCode: US
TelephoneNumber: 6082802700
FaxNumber:  
Practice Location
Address1: 802 E GORHAM ST
Address2:  
City: MADISON
State: WI
PostalCode: 537031524
CountryCode: US
TelephoneNumber: 6082804700
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/11/2020
LastUpdateDate: 06/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225C00000X WIY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor 

No ID Information.


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