Healthcare Provider Details

I. General information

NPI: 1053582437
Provider Name (Legal Business Name): KIRSTIN NORDLUND LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8353 SW 124TH ST SUITE 201
MIAMI FL
33156-5851
US

IV. Provider business mailing address

8353 SW 124TH ST SUITE 201
MIAMI FL
33156-5851
US

V. Phone/Fax

Practice location:
  • Phone: 786-732-6915
  • Fax:
Mailing address:
  • Phone: 786-732-6915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME0055848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: