Provider Demographics
NPI:1295166775
Name:GRANDON LAMA, KUNDU
Entity type:Individual
Prefix:
First Name:KUNDU
Middle Name:
Last Name:GRANDON LAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 WILLOW BEND DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6537
Mailing Address - Country:US
Mailing Address - Phone:320-492-8381
Mailing Address - Fax:
Practice Address - Street 1:3138 WILLOW BEND DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-6537
Practice Address - Country:US
Practice Address - Phone:320-492-8381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator