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Individual

INGRID LUNDGREN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2100 DIXON ST, DES MOINES, IA 50316-2174
(515) 265-1020
Mailing address
2100 DIXON ST, DES MOINES, IA 50316-2174
(515) 265-1020

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10004465
WA
363AM0700X
Medical Physician Assistant
PA002170
IA
363AM0700X
Medical Physician Assistant
Primary
PA13577
CA

Other

Enumeration date
06/11/2007
Last updated
01/04/2012
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