Active NPI
Heidi Lundeen, PAC
- Physician Assistant
- Bremerton, WA
National Provider Identifier
1053465765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10004723
- Practice address
- 2520 Cherry Ave
Bremerton, WA 98310-4229 - Phone
- (360) 377-3911
- NPI assigned
- Jan 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10004723 | WA | Primary |
Addresses
Primary practice location
2520 Cherry Ave
Bremerton, WA 98310-4229
Mailing address
901 E Old Ranch Rd
Allyn, WA 98524-7711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10004723 | WA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053465765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 E OLD RANCH RD",
"city": "ALLYN",
"state": "WA",
"postal_code": "985247711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2520 CHERRY AVE",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983104229",
"telephone_number": "360-377-3911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNDEEN",
"first_name": "HEIDI",
"credential": "PAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA10004723",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bremerton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.