| Doctor Name: | MS. CAROLYN SUE LUNDGREN |
| NPI Number: | 1083728240 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | C.P.N.P. |
| License Number: | 066304 |
| Business Practice Address: | 714 Gravois Rd Ste. 200 Fenton, MO - 630267727 |
| Business Phone Number: | 6363495437 |
| Business Fax Number: | 6363496663 |
| Mailing Address: | 714 Gravois Rd, Ste. 200 FENTON |
| State: | MO |
| Postal Code: | 630267727 |
| Phone Number: | 6363495437 |
| Fax Number: | 6363496663 |
| NPI Enumeration Date: | 08/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 066304 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |