Healthcare Provider Details

I. General information

NPI: 1255752630
Provider Name (Legal Business Name): LINDSEY NORTHNESS WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 W 9TH ST
WATERLOO IA
50702
US

IV. Provider business mailing address

312 9TH ST SW
WAVERLY IA
50677-2999
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-8000
  • Fax:
Mailing address:
  • Phone: 319-352-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF110422
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: