Healthcare Provider Details

I. General information

NPI: 1548091804
Provider Name (Legal Business Name): KATHRYN SCHEELA LUNDQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

5968 CHASEWOOD PKWY APT 3
MINNETONKA MN
55343-4334
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3700
  • Fax:
Mailing address:
  • Phone: 218-766-9253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2468735
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: