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NPI Code Detail

MEDICARE: BRIANNA LUNDGREN

MEDICARE: BRIANNA LUNDGREN
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
1106S00000XBehavior Technician
2104100000XSocial Worker

General Provider Information

NPI Number : 1760041644
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIANNA LUNDGREN
Provider Business Mailing Address
First Line : 6458 CITY WEST PKWY
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-3245
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3601 MINNESOTA DR STE 575
Second Line :
City : EDINA
State : MN
Zip : 55435-5213
Country : US
Telephone Number : 612-799-8975
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2019
Last Update Date : 06/27/2024

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Directions to “ BRIANNA LUNDGREN ” Practice Location

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