Provider Demographics
NPI:1497902688
Name:LUND, DERI L
Entity Type:Individual
Prefix:MRS
First Name:DERI
Middle Name:L
Last Name:LUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MEADOWBROOK
Mailing Address - Street 2:
Mailing Address - City:ESKO
Mailing Address - State:MN
Mailing Address - Zip Code:55733-5504
Mailing Address - Country:US
Mailing Address - Phone:218-348-8446
Mailing Address - Fax:
Practice Address - Street 1:118 MEADOWBROOK
Practice Address - Street 2:
Practice Address - City:ESKO
Practice Address - State:MN
Practice Address - Zip Code:55733-5504
Practice Address - Country:US
Practice Address - Phone:218-348-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR183723163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health