JACOB EDWARD LUNDORF


Address: 2100 S Liberty Dr Ste B, Bloomington, IN 47403
Phone: 8123365723

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).

Provider Overview

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

Taxonomy

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

Provider Secondary Practice Location

Address Telephone Number Fax Number
3000 Rogers Rd Ste 200, Wake Forest, NC 275873800 9194398860

Office Location

Street Address 2100 S LIBERTY DR STE B
City BLOOMINGTON
State IN
Zip Code 47403

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363L00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner

Taxonomy Definition

(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.

Providers in the same taxonomy and city

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
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City BLOOMINGTON
Zip Code 47403

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Dataset Information

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.

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