Provider Demographics
NPI:1922700012
Name:LUNDIN, ELLEN RAE (RN)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:RAE
Last Name:LUNDIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:RAE
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:60 DEAN STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375
Mailing Address - Country:US
Mailing Address - Phone:508-577-9516
Mailing Address - Fax:
Practice Address - Street 1:680 CENTRE STREET
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302
Practice Address - Country:US
Practice Address - Phone:508-941-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN118852163W00000X, 163WE0003X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency