Healthcare Provider Details

I. General information

NPI: 1790835445
Provider Name (Legal Business Name): DEBORAH MARIE LINDGREN-CLENDENEN RN, MN, GNP-BC, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST H2100
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

2508 COLFAX AVE S
MINNEAPOLIS MN
55405-2946
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-3900
  • Fax: 612-863-1681
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number115271-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4024-033
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR1088908
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: