Provider Demographics
NPI:1649903071
Name:LUNDQUIST, ANTHONY DALE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DALE
Last Name:LUNDQUIST
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 BRIGHTRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-6308
Mailing Address - Country:US
Mailing Address - Phone:979-479-1148
Mailing Address - Fax:
Practice Address - Street 1:1505 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3218
Practice Address - Country:US
Practice Address - Phone:281-342-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1086341363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care