Healthcare Provider Details

I. General information

NPI: 1013905256
Provider Name (Legal Business Name): CLARICE LUNDE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 LANGHORNE NEWTOWN RD
LANGHORNE PA
19047-1219
US

IV. Provider business mailing address

1205 LANGHORNE NEWTOWN RD
LANGHORNE PA
19047-1219
US

V. Phone/Fax

Practice location:
  • Phone: 215-710-2196
  • Fax: 215-710-2408
Mailing address:
  • Phone: 215-710-2196
  • Fax: 215-710-2408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN1787L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: