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Individual

KEVIN CARLYLE LUNDE X

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1321 MERRYWOOD CT, FARIBAULT, MN 55021-6529
(507) 491-2900
Mailing address
1321 MERRYWOOD CT, FARIBAULT, MN 55021-6529
(507) 491-2900

Taxonomy

Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1093031-1-AFC
DEPARTMENT OF HUMAN SERVICES
MN
01
RV934R
PROVIDER
MN
Enumeration date
05/13/2019
Last updated
05/13/2019
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