Provider Demographics
NPI:1265849921
Name:LUNDEVALL, KAJA (RN)
Entity Type:Individual
Prefix:
First Name:KAJA
Middle Name:
Last Name:LUNDEVALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 HIGHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60040-1553
Mailing Address - Country:US
Mailing Address - Phone:847-894-6546
Mailing Address - Fax:
Practice Address - Street 1:152 HIGHWOOD AVE
Practice Address - Street 2:
Practice Address - City:HIGHWOOD
Practice Address - State:IL
Practice Address - Zip Code:60040-1553
Practice Address - Country:US
Practice Address - Phone:847-894-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI199963-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse