Basic Information
| Provider Information | |||||||||
| NPI: | 1578299145 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUND | ||||||||
| FirstName: | MICHAELA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4651 CHARLOTTE PARK DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282171916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045296161 | ||||||||
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| Practice Location | |||||||||
| Address1: | 802 STATE AVE NE | ||||||||
| Address2: | |||||||||
| City: | WARROAD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 567632702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183864370 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2022 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 9320 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.