Provider Demographics
NPI:1891102828
Name:LUND, EMILY (LMP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LUND
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N TOWER AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-4627
Mailing Address - Country:US
Mailing Address - Phone:360-807-4767
Mailing Address - Fax:360-807-4875
Practice Address - Street 1:502 N TOWER AVE STE 4
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4627
Practice Address - Country:US
Practice Address - Phone:360-807-4767
Practice Address - Fax:360-807-4875
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60419808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist