Provider Demographics
NPI:1265175095
Name:LUND, ERIC EVAN
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:EVAN
Last Name:LUND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 BRIARWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-3337
Mailing Address - Country:US
Mailing Address - Phone:325-701-7112
Mailing Address - Fax:
Practice Address - Street 1:2118 BRIARWOOD ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-3337
Practice Address - Country:US
Practice Address - Phone:325-701-7112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ265925363LF0000X
NM66935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily