Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 6511 | MN |
NPI | 1013504505 |
---|---|
Provider Name | Catherine Ann Watson Lund |
First Address | St Louis Park, MN 55416-5701 |
Second Address | St Louis Park, MN 55416-5701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2020 |
Last Update Date | 30/12/2020 |