Provider Demographics
NPI:1033655782
Name:LINDSTROM, TRACY (DNP, APRN, NP-C)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:DNP, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S CLIFTON AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2954
Mailing Address - Country:US
Mailing Address - Phone:316-618-0035
Mailing Address - Fax:
Practice Address - Street 1:1515 S CLIFTON AVE STE 450
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2954
Practice Address - Country:US
Practice Address - Phone:316-618-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77532-052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily