Healthcare Provider Details

I. General information

NPI: 1750012738
Provider Name (Legal Business Name): MS. LOUWANA LINDSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 AUDUBON AVE
NEW YORK NY
10040-3403
US

IV. Provider business mailing address

1260 E 223RD ST
BRONX NY
10466-5802
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-9200
  • Fax:
Mailing address:
  • Phone: 347-880-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number691302
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: