Provider Demographics
NPI:1922719244
Name:LUNDELL, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:LUNDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COLD SPRING RD APT 115
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3192
Mailing Address - Country:US
Mailing Address - Phone:860-785-8832
Mailing Address - Fax:860-785-8165
Practice Address - Street 1:50 COLD SPRING RD APT 115
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3192
Practice Address - Country:US
Practice Address - Phone:860-785-8832
Practice Address - Fax:860-785-8165
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0001148376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker