Healthcare Provider Details

I. General information

NPI: 1043709124
Provider Name (Legal Business Name): ERICA WADE LUNDBERG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 CHICAGO AVE STE 550
MINNEAPOLIS MN
55404-4293
US

IV. Provider business mailing address

2525 CHICAGO AVE
MINNEAPOLIS MN
55404-4518
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-8000
  • Fax: 612-813-8005
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5823
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: