Provider Demographics
NPI:1801469739
Name:LUNDBOM, DANIRIS LEONOR (APRN)
Entity type:Individual
Prefix:
First Name:DANIRIS
Middle Name:LEONOR
Last Name:LUNDBOM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10085 DOUBLE R BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4832
Mailing Address - Country:US
Mailing Address - Phone:775-982-7260
Mailing Address - Fax:775-982-7268
Practice Address - Street 1:10085 DOUBLE R BLVD STE 310
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4832
Practice Address - Country:US
Practice Address - Phone:775-982-7260
Practice Address - Fax:775-982-7268
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV842530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV842530OtherAPRN LICENSE
NV15193864OtherCAQH NUMBER
NV15193864OtherCAQH NUMBER