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General NPI Number Information
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NPI Number | 1689088205
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Entity Type | Individual
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Provider Name | LACEY LUNDGREN APRN
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Gender | Female
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 1128 TX-21
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City | BASTROP
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State | TX
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Zip | 78602-4298
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Country | US
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Telephone | 844-215-4498
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Fax |
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Provider Business Mailing Address
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Address Line | 16800 LUND RD N
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City | ELGIN
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State | TX
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Zip | 78621-3830
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Country | US
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Telephone | 512-413-5190
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | AP125777
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP125777
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP125777
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License Number State | TX
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