Provider Demographics
NPI:1457381816
Name:LUNDGREN, KATHE DUANNE (EDD)
Entity Type:Individual
Prefix:DR
First Name:KATHE
Middle Name:DUANNE
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:MS
Other - First Name:KATHE
Other - Middle Name:DUANNE
Other - Last Name:LUNDGREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3805 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-2400
Mailing Address - Country:US
Mailing Address - Phone:661-323-7792
Mailing Address - Fax:661-323-7778
Practice Address - Street 1:3805 UNION AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-2400
Practice Address - Country:US
Practice Address - Phone:661-323-7792
Practice Address - Fax:661-323-7778
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5901103TC0700X
CA222749363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA781518OtherVALUE OPTIONS
CO3637436Medicaid
CA00PL59010Medicare UPIN
CO3637436Medicaid