Healthcare Provider Details

I. General information

NPI: 1386836914
Provider Name (Legal Business Name): LINDSAY MARIE JANDA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY TOBOLIC

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N20W22961 WATERTOWN RD
WAUKESHA WI
53186-1306
US

IV. Provider business mailing address

4622 WHITETAIL LN
NEW PORT RICHEY FL
34653-6542
US

V. Phone/Fax

Practice location:
  • Phone: 262-875-5070
  • Fax:
Mailing address:
  • Phone: 608-213-5867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2178
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: