Provider Demographics
NPI:1356627244
Name:LUNDHOLM, ROBERT WILLIAM (APRN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:LUNDHOLM
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 PACIFIC STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-1044
Mailing Address - Country:US
Mailing Address - Phone:402-504-3707
Mailing Address - Fax:402-504-3714
Practice Address - Street 1:6910 PACIFIC STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-1044
Practice Address - Country:US
Practice Address - Phone:402-504-3707
Practice Address - Fax:402-504-3714
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111311363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health