Provider Demographics
NPI:1225243124
Name:LUNDQUIST, KRISTINA MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:MARIE
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-3223
Mailing Address - Country:US
Mailing Address - Phone:973-657-0675
Mailing Address - Fax:
Practice Address - Street 1:305 OLDHAM RD
Practice Address - Street 2:PREAKNESS HEALTH CARE
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2208
Practice Address - Country:US
Practice Address - Phone:973-904-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN71040363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7565003Medicaid
NJ7565003Medicaid