Healthcare Provider Details

I. General information

NPI: 1659727782
Provider Name (Legal Business Name): MRS. LANA LINDGREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2016
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 S 3RD ST
LOMBARD IL
60148-4107
US

IV. Provider business mailing address

1219 S 3RD ST
LOMBARD IL
60148-4107
US

V. Phone/Fax

Practice location:
  • Phone: 312-608-4965
  • Fax:
Mailing address:
  • Phone: 312-608-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014023
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202213856NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: