Healthcare Provider Details

I. General information

NPI: 1336063593
Provider Name (Legal Business Name): LINDSEY NIELSEN- ADVANCED REGISTERED NURSING PRACTITIONER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 13TH ST STE B10
MODESTO CA
95354-2456
US

IV. Provider business mailing address

410 E ROCKINGHAM ST
ELKTON VA
22827-1508
US

V. Phone/Fax

Practice location:
  • Phone: 209-402-4427
  • Fax:
Mailing address:
  • Phone: 209-402-4427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY NIELSEN
Title or Position: PMHNP
Credential: PMHNP
Phone: 209-200-8380