Healthcare Provider Details

I. General information

NPI: 1285871277
Provider Name (Legal Business Name): SANDRA ROSWITHA LINDELL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SLEATER KINNEY RD SW CENTER OF MINDFUL HEALING STE B-169
LACEY WA
98503
US

IV. Provider business mailing address

8609 LYNDALE AVE S SUITE 201-C
BLOOMINGTON MN
55420
US

V. Phone/Fax

Practice location:
  • Phone: 360-972-7855
  • Fax: 360-282-1095
Mailing address:
  • Phone: 651-285-2144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR1676611
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1682
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61135817
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: