Healthcare Provider Details

I. General information

NPI: 1447372024
Provider Name (Legal Business Name): NANCY ANN LUNDBORG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 1ST AVE NE SUITE 310
MINNEAPOLIS MN
55413-2447
US

IV. Provider business mailing address

615 1ST AVE NE SUITE 310
MINNEAPOLIS MN
55413-2447
US

V. Phone/Fax

Practice location:
  • Phone: 612-436-0295
  • Fax: 612-436-0163
Mailing address:
  • Phone: 612-436-0295
  • Fax: 612-436-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR 049746-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: