Provider Demographics
NPI:1285780247
Name:LUNDBLAD, LINDA L (RN CNS APRN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:LUNDBLAD
Suffix:
Gender:F
Credentials:RN CNS APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WHITING PLACE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:781-740-1555
Mailing Address - Fax:781-740-4374
Practice Address - Street 1:210 WHITING PLACE
Practice Address - Street 2:SUITE 5
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-740-1555
Practice Address - Fax:781-740-4374
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133600364S00000X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NS0190Medicare ID - Type Unspecified