Doctor Name: | NICANDRA LUNDSTROM |
NPI Number: | 1952762718 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 238 Brookley Ave Sw Building 1300 Bolling Afb, DC - 200327704 |
Business Phone Number: | 8889991212 |
Business Fax Number: | |
Mailing Address: | 45 Sycamore Ave Apt 537, CHARLESTON |
State: | SC |
Postal Code: | 294076721 |
Phone Number: | 8643531673 |
Fax Number: | |
NPI Enumeration Date: | 03/08/2016 |
NPI Last Update Date: | 03/08/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |