Individual ProviderNicole S MungiolePhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3400 Spruce St, Ground Floor Dulles, Philadelphia, PA 19104-4206(215) 662-3005PECOS EnrollmentBased on the most recent information from CMS, provider Nicole S Mungiole does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1578610341Provider TypeIndividualFull NameMungiole, Nicole SCredentialPA-CGenderFemaleSole ProprietorNoEnumeration Date1/4/2007Last Updated3/14/2011Contact InformationPractice LocationPractice Address3400 Spruce St, Ground Floor Dulles, Philadelphia, PA 19104-4206Phone(215) 662-3005FaxUnlisted FaxMailing LocationMailing Address3400 Spruce St, Ground Floor Dulles, Philadelphia, PA 19104-4206PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363AM0700XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseMA050940Pennsylvania