Provider Demographics
NPI:1558103036
Name:LUNDBY, DEMRA (RN)
Entity type:Individual
Prefix:MRS
First Name:DEMRA
Middle Name:
Last Name:LUNDBY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4754
Mailing Address - Country:US
Mailing Address - Phone:651-364-6711
Mailing Address - Fax:
Practice Address - Street 1:10769 COUNTY HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-7243
Practice Address - Country:US
Practice Address - Phone:218-770-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2489641163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse