Provider Demographics
NPI:1215145073
Name:LUNDBERG, CHRISTINE F (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:F
Last Name:LUNDBERG
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-6010
Mailing Address - Country:US
Mailing Address - Phone:317-352-0569
Mailing Address - Fax:
Practice Address - Street 1:318 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-6010
Practice Address - Country:US
Practice Address - Phone:317-352-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28070650A163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant