Provider Demographics
NPI:1053569541
Name:LUND, MELANIE DAWN (RN, PEDIATRIC CNP)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:DAWN
Last Name:LUND
Suffix:
Gender:F
Credentials:RN, PEDIATRIC CNP
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:DAWN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3721 PAWNEE PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-1833
Mailing Address - Country:US
Mailing Address - Phone:214-514-1457
Mailing Address - Fax:
Practice Address - Street 1:1125 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1485
Practice Address - Country:US
Practice Address - Phone:712-255-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669125363LP0200X
IAC145924363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics