Provider Demographics
NPI:1659036424
Name:GUNDOLF, BRITTANY ANN
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:ANN
Last Name:GUNDOLF
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRITTANY
Other - Middle Name:ANN
Other - Last Name:MINERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1918 MECHANICSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-3147
Mailing Address - Country:US
Mailing Address - Phone:937-399-6101
Mailing Address - Fax:937-399-6109
Practice Address - Street 1:1918 MECHANICSBURG RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-3147
Practice Address - Country:US
Practice Address - Phone:937-399-6101
Practice Address - Fax:937-399-6109
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator