1336291673 NPI number — LAURIE A LUNN PT

Table of content: LAURIE A LUNN PT (NPI 1336291673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336291673 NPI number — LAURIE A LUNN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUNN
Provider First Name:
LAURIE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336291673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 COTTAGE GROVE RD
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06002-3064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-243-6571
Provider Business Mailing Address Fax Number:
860-243-6579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
184 E CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-2377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-243-6571
Provider Business Practice Location Address Fax Number:
860-243-6579
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  006579 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 4722 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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