Provider Demographics
NPI:1518967538
Name:LUNDGREN, KARIN ELIZABETH (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KARIN
Middle Name:ELIZABETH
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5073B LAUDERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-1329
Mailing Address - Country:US
Mailing Address - Phone:757-270-2426
Mailing Address - Fax:
Practice Address - Street 1:5070 LAUDERDALE AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-1379
Practice Address - Country:US
Practice Address - Phone:757-270-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN36873367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered