Provider Demographics
NPI:1659348902
Name:LUNDSTROM, MEGAN JANE (EDD, ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JANE
Last Name:LUNDSTROM
Suffix:
Gender:F
Credentials:EDD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S. GRAND AVE
Mailing Address - Street 2:E213 FIELD HOUSE
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242
Mailing Address - Country:US
Mailing Address - Phone:218-310-3732
Mailing Address - Fax:
Practice Address - Street 1:225 S. GRAND AVE
Practice Address - Street 2:E213 FIELD HOUSE
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:218-310-3732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer