Provider Demographics
NPI:1669036331
Name:SADECKI-LUND, CORINNE (APRN)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:SADECKI-LUND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N GLASSFORD HILL RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2285
Mailing Address - Country:US
Mailing Address - Phone:928-777-7820
Mailing Address - Fax:928-777-7821
Practice Address - Street 1:3100 N GLASSFORD HILL RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2285
Practice Address - Country:US
Practice Address - Phone:928-777-7621
Practice Address - Fax:928-777-7821
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.01855363LF0000X
AZ260933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily