Healthcare Provider Details

I. General information

NPI: 1922421148
Provider Name (Legal Business Name): JACQUELINE LINDOW RD, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12588 CARMEL CREEK RD UNIT 31
SAN DIEGO CA
92130-2318
US

IV. Provider business mailing address

12588 CARMEL CREEK RD UNIT 31
SAN DIEGO CA
92130-2318
US

V. Phone/Fax

Practice location:
  • Phone: 619-871-8827
  • Fax:
Mailing address:
  • Phone: 619-871-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023936
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1095189
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95198398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: