Healthcare Provider Details

I. General information

NPI: 1336075324
Provider Name (Legal Business Name): MICHELLE JULIA LUNDGREN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10014 ORLEANS LN N
MAPLE GROVE MN
55369-3540
US

IV. Provider business mailing address

10014 ORLEANS LN N
MAPLE GROVE MN
55369-3540
US

V. Phone/Fax

Practice location:
  • Phone: 218-428-7159
  • Fax:
Mailing address:
  • Phone: 218-428-7159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14464
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: