Provider Demographics
NPI:1073091591
Name:FIECHTNER, LINDSEY JO (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:JO
Last Name:FIECHTNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 LARICK DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-5646
Mailing Address - Country:US
Mailing Address - Phone:319-350-7008
Mailing Address - Fax:
Practice Address - Street 1:2375 EDGEWOOD RD SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-4736
Practice Address - Country:US
Practice Address - Phone:319-396-1983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093065363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant