Provider Demographics
NPI:1679041404
Name:LUNDIN, CARA ANN (AGNP-C)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:ANN
Last Name:LUNDIN
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:ANN
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 BRIDGEPORT WAY W STE 404
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4614
Mailing Address - Country:US
Mailing Address - Phone:253-534-7000
Mailing Address - Fax:206-244-3991
Practice Address - Street 1:2901 BRIDGEPORT WAY W STE 404
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4614
Practice Address - Country:US
Practice Address - Phone:253-534-7000
Practice Address - Fax:206-244-3991
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60898966363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2126007Medicaid