MEDICARE: ANTHONY DALE LUNDQUIST NURSE PRACTITIONER

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	363LP2300X	Primary Care Nurse Practitioner	1086341	TX

General Provider Information

NPI Number	:	1649903071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY DALE LUNDQUIST NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	4311 BRIGHTRIDGE CT
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77471-6308
Country	:	US
Telephone Number	:	979-479-1148
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 LIBERTY ST
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-3218
Country	:	US
Telephone Number	:	281-342-9500
Fax Number	:

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

Provider Enumeration Date	:	07/04/2022
Last Update Date	:	07/04/2022

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