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General NPI Number Information
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NPI Number | 1457051575
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Entity Type | Individual
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Provider Name | BREANNA NIKKOLE LINDEMANN LSA
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Gender | Female
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1600 11TH ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4388
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Country | US
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Telephone | 940-764-6724
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Fax |
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Provider Business Mailing Address
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Address Line | 4405 UNIVERSITY AVE
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2422
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Country | US
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Telephone | 940-224-3766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA00908
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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