Provider Demographics
NPI:1861528317
Name:ARMY NATIONAL GUARD MEDICAL COMMAND
Entity type:Organization
Organization Name:ARMY NATIONAL GUARD MEDICAL COMMAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:LUNDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-224-8898
Mailing Address - Street 1:89-202 WAIEA PL
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-4144
Mailing Address - Country:US
Mailing Address - Phone:808-224-8898
Mailing Address - Fax:
Practice Address - Street 1:89-202 WAIEA PL
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-4144
Practice Address - Country:US
Practice Address - Phone:808-224-8898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI36905374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing PersonnelGroup - Multi-Specialty