Healthcare Provider Details

I. General information

NPI: 1164050779
Provider Name (Legal Business Name): EMILY LUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 FLOSSIE DR
GREENDALE IN
47025-8424
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-655-8910
  • Fax: 859-655-8911
Mailing address:
  • Phone: 859-655-8910
  • Fax: 859-655-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number02008663A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number05511
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: