Individual
JOHN D LUNDEBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2 S HOSPITAL DR, MURPHYSBORO, IL 62966-3333
(618) 684-3156
(618) 529-0529
Mailing address
1239 E MAIN ST, CARBONDALE, IL 62901-3175
(618) 457-5200
(618) 529-0586
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
041181507
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209001325
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
GROUP PTAN
IL
Enumeration date
09/09/2005
Last updated
04/13/2020
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