Provider Demographics
NPI:1689006389
Name:RUNDSTROM, LINDA ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANN
Last Name:RUNDSTROM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05455-5480
Mailing Address - Country:US
Mailing Address - Phone:802-782-3718
Mailing Address - Fax:
Practice Address - Street 1:38 WHIPPLE ROAD
Practice Address - Street 2:BLANCHARD RESIDENCE
Practice Address - City:SOUTH HERO
Practice Address - State:VT
Practice Address - Zip Code:05486
Practice Address - Country:US
Practice Address - Phone:802-372-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT025.0006218164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse