Provider Demographics
NPI:1114415205
Name:LUNDGREN, KAITLYN JAMIE
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:JAMIE
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:JAMIE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:3220 W IL ROUTE 60
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-4271
Practice Address - Country:US
Practice Address - Phone:847-837-8442
Practice Address - Fax:847-837-8542
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017501363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily