Healthcare Provider Details

I. General information

NPI: 1366373698
Provider Name (Legal Business Name): LINDSAY ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E JACKSON ST
MORTON IL
61550-1626
US

IV. Provider business mailing address

220 E JACKSON ST
MORTON IL
61550-1626
US

V. Phone/Fax

Practice location:
  • Phone: 309-266-6705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019036178
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: