Provider Demographics
NPI:1033364245
Name:LINDELL, TAMI DAWN (DNP, FNP, GNP, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:TAMI
Middle Name:DAWN
Last Name:LINDELL
Suffix:
Gender:F
Credentials:DNP, FNP, GNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 WOODBERRY DR SE
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-8301
Mailing Address - Country:US
Mailing Address - Phone:218-556-2766
Mailing Address - Fax:
Practice Address - Street 1:112 1ST ST W STE 204-205
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4002
Practice Address - Country:US
Practice Address - Phone:218-670-5239
Practice Address - Fax:218-888-8033
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2008000923363LF0000X
MN2008004394363LG0600X
MN2012006859363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1033364245Medicaid