Provider Demographics
NPI:1275719338
Name:LUND, ANGIE R (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:R
Last Name:LUND
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 E VEST AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8482
Mailing Address - Country:US
Mailing Address - Phone:480-279-6815
Mailing Address - Fax:480-279-6805
Practice Address - Street 1:3333 E VEST AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8482
Practice Address - Country:US
Practice Address - Phone:480-279-6815
Practice Address - Fax:480-279-6805
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN144296163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool