Provider Demographics
NPI:1548387350
Name:LUND, PAMELA RAE (LPN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RAE
Last Name:LUND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 YOCK WOCK RD
Mailing Address - Street 2:
Mailing Address - City:PORT NORRIS
Mailing Address - State:NJ
Mailing Address - Zip Code:08349-3812
Mailing Address - Country:US
Mailing Address - Phone:856-785-8180
Mailing Address - Fax:
Practice Address - Street 1:6601 YOCK WOCK RD
Practice Address - Street 2:
Practice Address - City:PORT NORRIS
Practice Address - State:NJ
Practice Address - Zip Code:08349-3812
Practice Address - Country:US
Practice Address - Phone:856-785-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05120400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse