Provider Demographics
NPI:1497973291
Name:LUND, JANELLE BARTOL (RDLD,CDE)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:BARTOL
Last Name:LUND
Suffix:
Gender:F
Credentials:RDLD,CDE
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:L
Other - Last Name:BARTOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDLD
Mailing Address - Street 1:750 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746
Mailing Address - Country:US
Mailing Address - Phone:218-262-4881
Mailing Address - Fax:
Practice Address - Street 1:750 E 34TH ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746
Practice Address - Country:US
Practice Address - Phone:218-262-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1548133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered