Healthcare Provider Details

I. General information

NPI: 1376850396
Provider Name (Legal Business Name): HEATHER COLLEEN LUNDBERG ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 FRANCE AVE S SUITE 610
EDINA MN
55435-2129
US

IV. Provider business mailing address

2086 BLOMQUIST AVE
WHITE BEAR LAKE MN
55110-4702
US

V. Phone/Fax

Practice location:
  • Phone: 952-836-3741
  • Fax: 952-836-3646
Mailing address:
  • Phone: 651-429-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberR 158404-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: