Provider Demographics
NPI:1073806477
Name:LINDSTROM, RANDI JEWELL (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDI
Middle Name:JEWELL
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 41ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136
Mailing Address - Country:US
Mailing Address - Phone:206-900-2492
Mailing Address - Fax:
Practice Address - Street 1:5916 41ST AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1604
Practice Address - Country:US
Practice Address - Phone:206-900-2492
Practice Address - Fax:206-900-2492
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2224207P00000X
WAOP60318649207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program