Provider Demographics
NPI:1821570847
Name:LUND, SHIRLEY MARIE (RN, MSN)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:MARIE
Last Name:LUND
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SOUTHEASTERN DIRECTIONS FOR LIFE
Mailing Address - Street 2:2000 S. SUMMIT AVE.
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105
Mailing Address - Country:US
Mailing Address - Phone:605-336-0510
Mailing Address - Fax:605-336-3779
Practice Address - Street 1:2000 S SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2727
Practice Address - Country:US
Practice Address - Phone:605-335-8905
Practice Address - Fax:605-275-6541
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCS004001364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family