Individual
RUSSELL WILLIAM LUNDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
90 E 200 N, LOGAN, UT 84321-4034
(435) 752-0791
Mailing address
166 W 100 N, SMITHFIELD, UT 84335-2002
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
171M00000X
UT
Other
Enumeration date
12/08/2010
Last updated
12/08/2010
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