Healthcare Provider Details

I. General information

NPI: 1366480899
Provider Name (Legal Business Name): JOY LEE LINDGREN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W COUNTRY CLUB RD
ROSWELL NM
88201-5209
US

IV. Provider business mailing address

1487 15TH ST N
WAHPETON ND
58075-3518
US

V. Phone/Fax

Practice location:
  • Phone: 505-622-8170
  • Fax: 505-624-8711
Mailing address:
  • Phone: 701-899-0642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR54374
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: