Healthcare Provider Details

I. General information

NPI: 1265355648
Provider Name (Legal Business Name): CHARIDEE ANN LUND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W ELM AVE
FLAGSTAFF AZ
86001-1562
US

IV. Provider business mailing address

7783 W SWEETWATER TRL
FLAGSTAFF AZ
86001-8158
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number302405
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: