Healthcare Provider Details

I. General information

NPI: 1104984772
Provider Name (Legal Business Name): DIANA R LUNDQUIST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7815 FARNAM DR CHILDREN'S HOME HEALTHCARE'S WORLD
OMAHA NE
68114-4564
US

IV. Provider business mailing address

7815 FARNAM DR CHILDREN'S HOME HEALTHCARE'S WORLD
OMAHA NE
68114-4564
US

V. Phone/Fax

Practice location:
  • Phone: 402-926-2322
  • Fax: 402-926-2722
Mailing address:
  • Phone: 402-926-2322
  • Fax: 402-926-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number751
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: