Provider Demographics
NPI:1598793556
Name:LUNDH, MARGO LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:LYNN
Last Name:LUNDH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6095 MARSHALEE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6053
Mailing Address - Country:US
Mailing Address - Phone:410-379-3522
Mailing Address - Fax:
Practice Address - Street 1:6095 MARSHALEE DR
Practice Address - Street 2:STE 100
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6053
Practice Address - Country:US
Practice Address - Phone:410-379-3522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR170992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS51775Medicare UPIN