Healthcare Provider Details

I. General information

NPI: 1821295296
Provider Name (Legal Business Name): KRISTIN LUND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E CENTER ST SUITE 10
MANCHESTER CT
06040-5215
US

IV. Provider business mailing address

116 E CENTER ST SUITE 10
MANCHESTER CT
06040-5215
US

V. Phone/Fax

Practice location:
  • Phone: 860-647-9183
  • Fax: 860-647-0582
Mailing address:
  • Phone: 860-647-9183
  • Fax: 860-647-0582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001893
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number001893
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: