Healthcare Provider Details

I. General information

NPI: 1780881243
Provider Name (Legal Business Name): LINDSEY D. CAUDLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 N. MAIN STREET
TUBA CITY AZ
86045-0600
US

IV. Provider business mailing address

PO BOX 305
TUBA CITY AZ
86045-0305
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-2680
  • Fax: 928-283-2952
Mailing address:
  • Phone: 928-283-2680
  • Fax: 928-283-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: