Provider Demographics
NPI:1669462875
Name:EDLUND, LUCINDA L (CRNA)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:L
Last Name:EDLUND
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:EDLUND
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 202149
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99520-2149
Mailing Address - Country:US
Mailing Address - Phone:907-258-2149
Mailing Address - Fax:907-258-2147
Practice Address - Street 1:2801 DEBARR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2932
Practice Address - Country:US
Practice Address - Phone:907-258-2149
Practice Address - Fax:907-258-2147
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK18397163W00000X
AK185367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRNA0014Medicaid
AK430047713OtherMEDICARE RAILROAD
S41309Medicare UPIN
AKRNA0014Medicaid