Provider Demographics
NPI:1730746090
Name:LUND, JONELLE LYNN (RN BSN IBCLC)
Entity type:Individual
Prefix:
First Name:JONELLE
Middle Name:LYNN
Last Name:LUND
Suffix:
Gender:F
Credentials:RN BSN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 BOSLEY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:17327-7713
Mailing Address - Country:US
Mailing Address - Phone:616-307-2931
Mailing Address - Fax:
Practice Address - Street 1:4145 BOSLEY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:PA
Practice Address - Zip Code:17327-7713
Practice Address - Country:US
Practice Address - Phone:616-307-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN705638163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty