Provider Demographics
NPI:1871886127
Name:LUNDGREN, ERICA (CLD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 GOLF COURSE DR
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-2101
Mailing Address - Country:US
Mailing Address - Phone:303-503-0237
Mailing Address - Fax:
Practice Address - Street 1:5412 GOLF COURSE DR
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-2101
Practice Address - Country:US
Practice Address - Phone:303-503-0237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist