Provider Demographics
NPI:1821388372
Name:EDLUND, LORI ANN (CNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:EDLUND
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 COUNTY ROAD 120
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4872
Mailing Address - Country:US
Mailing Address - Phone:320-202-8949
Mailing Address - Fax:
Practice Address - Street 1:402 RED RIVER AVE N
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-1521
Practice Address - Country:US
Practice Address - Phone:320-685-8641
Practice Address - Fax:320-685-4020
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-145217-8363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1821388372Medicaid
MN500006640Medicare PIN