Healthcare Provider Details

I. General information

NPI: 1366749012
Provider Name (Legal Business Name): LINDSEY MARIE SPRINKLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 N CICERO AVE
CHICAGO IL
60646-5717
US

IV. Provider business mailing address

7518 CONNIE LN
NORTH RICHLAND HILLS TX
76182-4670
US

V. Phone/Fax

Practice location:
  • Phone: 773-777-7790
  • Fax:
Mailing address:
  • Phone: 708-288-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10334
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: