Carolyn Sue Lundgren, C.P.N.P.

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

066304 Issued in MO

Practice address

714 Gravois Rd
Ste. 200
Fenton, MO 63026-7727

Phone

(636) 349-5437

Fax

(636) 349-6663

NPI assigned

Aug 17, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Pediatric Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083728240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 GRAVOIS RD",
            "address_2": "STE. 200",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267727",
            "telephone_number": "636-349-5437",
            "fax_number": "636-349-6663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 GRAVOIS RD",
            "address_2": "STE. 200",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267727",
            "telephone_number": "636-349-5437",
            "fax_number": "636-349-6663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUNDGREN",
        "first_name": "CAROLYN",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "C.P.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "066304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Nurse Practitioner in Fenton, MO
• Providers in Fenton, MO by specialty
• Pediatric Nurse Practitioner in Missouri

• 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.

Verify at the official NPI Registry.