Provider Demographics
NPI:1891061727
Name:AMUNDSON, LYNNE MARLENE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARLENE
Last Name:AMUNDSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 WOODGATE PT
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2448
Mailing Address - Country:US
Mailing Address - Phone:651-681-8042
Mailing Address - Fax:
Practice Address - Street 1:4441 WOODGATE PT
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2448
Practice Address - Country:US
Practice Address - Phone:651-681-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR97384-9163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health