Healthcare Provider Details

I. General information

NPI: 1891118360
Provider Name (Legal Business Name): ERIK GUDMUNDSON ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10293 209TH ST W
LAKEVILLE MN
55044-9735
US

IV. Provider business mailing address

10293 209TH ST W
LAKEVILLE MN
55044-9735
US

V. Phone/Fax

Practice location:
  • Phone: 716-562-8872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1051
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: