Provider Demographics
NPI:1083058119
Name:LUNDGREN, NATALIE JUNE (OTS)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:JUNE
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:OTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W 110TH ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2046
Mailing Address - Country:US
Mailing Address - Phone:415-810-2372
Mailing Address - Fax:
Practice Address - Street 1:425 DIVISADERO ST STE 300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2242
Practice Address - Country:US
Practice Address - Phone:415-551-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program