Provider Demographics
NPI:1821295296
Name:LUND, KRISTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:LUND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E CENTER ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5215
Mailing Address - Country:US
Mailing Address - Phone:860-647-9183
Mailing Address - Fax:860-647-0582
Practice Address - Street 1:116 E CENTER ST
Practice Address - Street 2:SUITE 10
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5215
Practice Address - Country:US
Practice Address - Phone:860-647-9183
Practice Address - Fax:860-647-0582
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001893207T00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery