MEDICARE: KATHY ANN LUNDQUIST RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	080045364RN	OR

General Provider Information

NPI Number	:	1689998239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY ANN LUNDQUIST RN

Provider Business Mailing Address
First Line	:	13900 NW MASON HILL RD
Second Line	:
City	:	NORTH PLAINS
State	:	OR
Zip	:	97133-8102
Country	:	US
Telephone Number	:	503-647-2060
Fax Number	:

Provider Business Practice Location Address
First Line	:	13900 NW MASON HILL RD
Second Line	:
City	:	NORTH PLAINS
State	:	OR
Zip	:	97133-8102
Country	:	US
Telephone Number	:	503-647-2060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	03/24/2010

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