Healthcare Provider Details

I. General information

NPI: 1285570069
Provider Name (Legal Business Name): LINDSAY ANN LYDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY ANN LAVENDER RN

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6148 W COUNTY ROAD 650 N
NORTH SALEM IN
46165-9447
US

IV. Provider business mailing address

6148 W COUNTY ROAD 650 N
NORTH SALEM IN
46165-9447
US

V. Phone/Fax

Practice location:
  • Phone: 317-407-5436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03260032
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: