Provider Demographics
NPI:1033588215
Name:ROBERT LUNDHOLM APRN, LLC
Entity Type:Organization
Organization Name:ROBERT LUNDHOLM APRN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LUNDHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-504-3707
Mailing Address - Street 1:2808 S 80TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3253
Mailing Address - Country:US
Mailing Address - Phone:402-504-3707
Mailing Address - Fax:402-504-3714
Practice Address - Street 1:2808 S 80TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3253
Practice Address - Country:US
Practice Address - Phone:402-504-3707
Practice Address - Fax:402-504-3714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111311363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty