Provider Demographics
NPI:1942425434
Name:LUND, KATRINA A (MD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:A
Last Name:LUND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7200 N STATE HWY 161
Mailing Address - Street 2:SUITE 220
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3830
Mailing Address - Country:US
Mailing Address - Phone:214-689-7806
Mailing Address - Fax:214-689-5970
Practice Address - Street 1:7200 N STATE HWY 161
Practice Address - Street 2:SUITE 220
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3830
Practice Address - Country:US
Practice Address - Phone:214-689-7806
Practice Address - Fax:214-689-5970
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX624918363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210223801Medicaid
TX624918OtherRN LIC NUMBER
TX624918OtherRN LIC NUMBER