Healthcare Provider Details

I. General information

NPI: 1174453021
Provider Name (Legal Business Name): NINA LUNN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SECOND AVE
WALTHAM MA
02451-1158
US

IV. Provider business mailing address

130 SECOND AVE
WALTHAM MA
02451-1158
US

V. Phone/Fax

Practice location:
  • Phone: 781-434-6543
  • Fax:
Mailing address:
  • Phone: 781-434-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR1000X
TaxonomyReproductive Endocrinology/Infertility Registered Nurse
License NumberRN2361639
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: