Healthcare Provider Details

I. General information

NPI: 1396023263
Provider Name (Legal Business Name): LINDSAY DIANE ALLEN WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 05/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 S MICHIGAN AVE SUITE 130 N
CHICAGO IL
60603-3200
US

IV. Provider business mailing address

18 S MICHIGAN AVE 6TH FLOOR
CHICAGO IL
60603-3200
US

V. Phone/Fax

Practice location:
  • Phone: 312-592-6700
  • Fax: 312-592-6701
Mailing address:
  • Phone: 312-592-6700
  • Fax: 312-592-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number309.005225
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number209.008480
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: