Healthcare Provider Details

I. General information

NPI: 1295183069
Provider Name (Legal Business Name): LINDSAY THIEMKEY GORDON DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 TYDD ST
EUREKA CA
95501-1284
US

IV. Provider business mailing address

3170 WILLOWCREEK RD
PORTAGE IN
46368-4424
US

V. Phone/Fax

Practice location:
  • Phone: 707-441-1624
  • Fax: 707-441-1253
Mailing address:
  • Phone: 219-764-7236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28200956A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: