Healthcare Provider Details

I. General information

NPI: 1568628493
Provider Name (Legal Business Name): AMBUR MARIE LINDSTROM-METTE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBUR LINDSTROM

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6524 E CARONDELET DR BLDGE D
TUCSON AZ
85710-2117
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-290-1100
  • Fax: 520-290-8997
Mailing address:
  • Phone: 520-682-4560
  • Fax: 520-682-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3110
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN119218
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: