Healthcare Provider Details

I. General information

NPI: 1801469739
Provider Name (Legal Business Name): DANIRIS LEONOR LUNDBOM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 03/07/2023
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10085 DOUBLE R BLVD STE 310
RENO NV
89521-4832
US

IV. Provider business mailing address

10085 DOUBLE R BLVD STE 310
RENO NV
89521-4832
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-7260
  • Fax: 775-982-7268
Mailing address:
  • Phone: 775-982-7260
  • Fax: 775-982-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number842530
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: