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General NPI Number Information
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NPI Number | 1376301994
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Entity Type | Organization
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Legal Business Name | LINDGREN FUNCTIONAL MEDICINE
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Dates
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Enumeration Date | 03/08/2024
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 2593 DEVELOPMENT DR STE 240
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City | GREEN BAY
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State | WI
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Zip | 54311-4287
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Country | US
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Telephone | 920-737-1625
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Fax |
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Provider Business Mailing Address
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Address Line | 2593 DEVELOPMENT DR STE 240
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City | GREEN BAY
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State | WI
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Zip | 54311-4287
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Country | US
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Telephone | 920-737-1625
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Fax |
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | SHANNON KANTER
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Credential | BSN, RN
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Telephone | 920-548-1967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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