JACOB EDWARD LUNDORF (NPI# 1598251175) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1598251175 |
Entity Type | Individual |
Full Name | JACOB EDWARD LUNDORF |
Credential | AGNP |
Practice Address |
2100 S Liberty Dr Ste B Bloomington IN 47403 |
Mailing Address |
706 W Kirkwood Ave Bloomington IN 47404-5046 |
Practice Telephone | 8123365723 |
Mailing Telephone | 5748502069 |
Enumeration Date | 2018-07-06 |
Last Update Date | 2019-11-19 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 71009487B | IN | Physician Assistants & Advanced Practice Nursing Providers |
N | 363L00000X | Nurse Practitioner | 5010695 | NC | Physician Assistants & Advanced Practice Nursing Providers |
Address | Telephone Number | Fax Number |
---|---|---|
3000 Rogers Rd Ste 200, Wake Forest, NC 275873800 | 9194398860 |
Street Address |
2100 S LIBERTY DR STE B |
City | BLOOMINGTON |
State | IN |
Zip Code | 47403 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1043783673 | Brook Whitaker | Registered Nurse | 4011 S. Monroe Medical Park Blvd, Bloomington, IN 47403 | 2019-01-07 |
1568973717 | Gregory Thomas Dougan | Physician Assistant | 418 South Landmark Avenue, Bloomington, IN 47403 | 2017-10-16 |
1295276160 | Indiana Center for Recovery, LLC | Substance Abuse Rehabilitation Facility | 1004 W 1st Street, Bloomington, IN 47403 | 2017-03-13 |
1144694217 | Kayla Dewolf | Specialist/Technologist | 1471 W Allen St, Bloomington, IN 47403 | 2015-11-30 |
1164806444 | Monroe Hosoital | General Acute Care Hospital | 4011 Monroe Medical Park, Bloomington, IN 47403 | 2015-07-16 |
1821411588 | Jennifer Turner | Occupational Therapy Assistant | 1023 West Main St, Swiss Villa, Vevay, IN 47403 | 2014-01-30 |
1104170232 | Kendall Basore | Social Worker | 445 S. Landmark Ave., Bloomington, IN 47403 | 2012-10-26 |
1568715886 | Indiana Hearing LLC | Hearing Aid Equipment | 2019 S Liberty Dr, Bloomington, IN 47403 | 2012-10-24 |
1679870232 | Accurate Hearing Services | Clinic/Center | 1355 W Second St, #3, Bloomington, IN 47403 | 2011-02-17 |
1528369428 | Center for Optimal Health | Obstetrics & Gynecology | 415 W First Street, Bloomington, IN 47403 | 2010-11-09 |
Find all providers in zip 47403 |
Taxonomy Code | 363L00000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1821615485 | Denise Michelle Alexander | Nurse Practitioner | 815 West 2nd Street, Bloomington, IN 47403-2212 | 2020-06-30 |
1578198420 | Jessica Ashley Wargo | Nurse Practitioner | 1319 N Veterans Pkwy Ste 3b, Bloomington, IL 61704-6428 | 2020-03-10 |
1275084170 | Christina Lisowski | Nurse Practitioner | 2412 E Washington St Ste 4b, Bloomington, IL 61704-1613 | 2016-10-17 |
1528479771 | Cura Medical Group, LLC | Nurse Practitioner | 13 Red Stone Ct, Bloomington, IL 61704-8403 | 2014-05-09 |
1790118586 | Anastasia Kovalaske | Nurse Practitioner | 1401 Eastland Dr Suite B, Bloomington, IL 61761-3514 | 2013-08-15 |
1528342730 | Theresa Rose Woodard | Nurse Practitioner | 3209 W Fullerton Pike Ste E, Bloomington, IN 47403-4060 | 2011-10-06 |
1205160975 | Stacey Kaye England | Nurse Practitioner | 123 S Franklin Rd, Bloomington, IN 47404-5296 | 2009-09-28 |
1700065505 | Joan Marie Goodman | Nurse Practitioner | 383 S. Park Ridge Rd., Ste 102, Bloomington, IN 47401-8574 | 2007-10-29 |
1376638262 | Rose M Seguin | Nurse Practitioner | 421 S College Ave, Bloomington, IN 47403-1514 | 2006-10-04 |
1396789210 | Kimberly Nord | Nurse Practitioner | 1405 Eastland Dr, Bloomington, IL 61701-3514 | 2006-06-15 |
Find all providers in BLOOMINGTON |
City | BLOOMINGTON |
Zip Code | 47403 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.