Provider Demographics
NPI:1801435391
Name:LUND, BRIANNE ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:ELIZABETH
Last Name:LUND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BEIANNE
Other - Middle Name:ELIZABETH
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8540 QUADAY AVE NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-6522
Mailing Address - Country:US
Mailing Address - Phone:763-441-0298
Mailing Address - Fax:763-441-0591
Practice Address - Street 1:8540 QUADAY AVE NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-6522
Practice Address - Country:US
Practice Address - Phone:763-441-0298
Practice Address - Fax:763-441-0591
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant