Provider Demographics
NPI:1245482330
Name:LUND, AMBER NICOLE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:LUND
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:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MN
Mailing Address - Zip Code:56315-0239
Mailing Address - Country:US
Mailing Address - Phone:320-524-2846
Mailing Address - Fax:
Practice Address - Street 1:105 W FRONT ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MN
Practice Address - Zip Code:56315-4509
Practice Address - Country:US
Practice Address - Phone:320-524-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist