Provider Demographics
NPI:1114489457
Name:LUNDY, NICOLE (MSN, CRNP, FNP-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LUNDY
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 W MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1103
Mailing Address - Country:US
Mailing Address - Phone:717-844-0046
Mailing Address - Fax:717-844-3772
Practice Address - Street 1:1656 W MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1103
Practice Address - Country:US
Practice Address - Phone:717-844-0046
Practice Address - Fax:717-844-3772
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020301363LF0000X, 202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1538197348Medicaid