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General NPI Number Information
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NPI Number | 1114231065
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Entity Type | Individual
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Provider Name | MIRIAM LUNDY PMHNP
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Gender | Female
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 3031 TELEGRAPH AVE
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City | OAKLAND
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State | CA
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Zip | 94609-3205
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Country | US
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Telephone | 510-596-8130
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Fax |
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Provider Business Mailing Address
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Address Line | 18 COWPER AVE
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City | KENSINGTON
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State | CA
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Zip | 94707-1006
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Country | US
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Telephone | 510-316-8344
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95001154
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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