Healthcare Provider Details

I. General information

NPI: 1336475441
Provider Name (Legal Business Name): TERESA M LINDSEY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17263 S BOONE RD
COLUMBIA STATION OH
44028-9656
US

IV. Provider business mailing address

17263 S BOONE RD
COLUMBIA STATION OH
44028-9656
US

V. Phone/Fax

Practice location:
  • Phone: 440-343-6865
  • Fax: 440-236-5961
Mailing address:
  • Phone: 440-343-6865
  • Fax: 440-236-5961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.136721-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: