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NPI Code Detail

MEDICARE: MRS. LINDSEY MACIEL PEDERSON APN

MEDICARE: MRS. LINDSEY MACIEL PEDERSON APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner209015924IL

General Provider Information

NPI Number : 1093243339
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LINDSEY MACIEL PEDERSON APN
Provider Business Mailing Address
First Line : 1702 W ERIE ST APT 1
Second Line :
City : CHICAGO
State : IL
Zip : 60622-6019
Country : US
Telephone Number : 815-735-1140
Fax Number :
Provider Business Practice Location Address
First Line : 60 E DELAWARE PL STE 1420
Second Line :
City : CHICAGO
State : IL
Zip : 60611-1495
Country : US
Telephone Number : 312-440-5127
Fax Number : 312-440-5127
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2017
Last Update Date : 04/24/2020

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Directions to “ MRS. LINDSEY MACIEL PEDERSON APN” Practice Location

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