MEDICARE: MRS. LUNDI ANN CORNELL LAC, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	5401000240	MI

General Provider Information

NPI Number	:	1467639682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LUNDI ANN CORNELL LAC, RN

Provider Business Mailing Address
First Line	:	7961 ISLAND CT
Second Line	:
City	:	STANWOOD
State	:	MI
Zip	:	49346-8920
Country	:	US
Telephone Number	:	406-850-1009
Fax Number	:

Provider Business Practice Location Address
First Line	:	1883 W MONROE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MI
Zip	:	48880-8702
Country	:	US
Telephone Number	:	406-850-1009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	04/29/2025

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