Provider Demographics
NPI:1164810958
Name:LUNDBORG, KATHY (CMS-CHT, FIBH)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:LUNDBORG
Suffix:
Gender:F
Credentials:CMS-CHT, FIBH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2038
Mailing Address - Country:US
Mailing Address - Phone:406-640-4386
Mailing Address - Fax:
Practice Address - Street 1:110 S DAKOTA ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2038
Practice Address - Country:US
Practice Address - Phone:406-640-4386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist