Provider Demographics
NPI:1104984772
Name:LUNDQUIST, DIANA R (PA-C)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:R
Last Name:LUNDQUIST
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:7815 FARNAM DR
Mailing Address - Street 2:CHILDREN'S HOME HEALTHCARE'S WORLD
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4564
Mailing Address - Country:US
Mailing Address - Phone:402-926-2322
Mailing Address - Fax:402-926-2722
Practice Address - Street 1:7815 FARNAM DR
Practice Address - Street 2:CHILDREN'S HOME HEALTHCARE'S WORLD
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4564
Practice Address - Country:US
Practice Address - Phone:402-926-2322
Practice Address - Fax:402-926-2722
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE751363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical