Healthcare Provider Details

I. General information

NPI: 1306639992
Provider Name (Legal Business Name): GABRIELLA LUNDIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 E MEXICO AVE STE 100
DENVER CO
80210-3944
US

IV. Provider business mailing address

3900 E MEXICO AVE
DENVER CO
80210-3940
US

V. Phone/Fax

Practice location:
  • Phone: 303-222-9546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number1694501
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: