Provider Demographics
NPI:1861769309
Name:LUND, NICOLE (RN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:LUND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1363
Mailing Address - Country:US
Mailing Address - Phone:585-596-2117
Mailing Address - Fax:585-596-2120
Practice Address - Street 1:126 W STATE ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1363
Practice Address - Country:US
Practice Address - Phone:585-596-2117
Practice Address - Fax:585-596-2120
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22445678163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool