Provider Demographics
NPI:1629090170
Name:LUNDBERG, CHRISTINE A (RD, CD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:LUNDBERG
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:A
Other - Last Name:PALECEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:900 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-3114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:824 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3112
Practice Address - Country:US
Practice Address - Phone:715-342-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2217-029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered