Healthcare Provider Details

I. General information

NPI: 1972883486
Provider Name (Legal Business Name): SALENA LUNDQUIST FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 1ST AVE SE
WATERTOWN SD
57201-4402
US

IV. Provider business mailing address

506 1ST AVE SE
WATERTOWN SD
57201-4402
US

V. Phone/Fax

Practice location:
  • Phone: 605-886-8482
  • Fax:
Mailing address:
  • Phone: 605-886-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR034742
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000668
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: