Provider Demographics
NPI:1083382618
Name:CHARGOT, LINDSAY MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MARIE
Last Name:CHARGOT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:MARIE
Other - Last Name:LUNDGREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:4195 HAVENS RD
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48428-9329
Mailing Address - Country:US
Mailing Address - Phone:517-712-6868
Mailing Address - Fax:
Practice Address - Street 1:4195 HAVENS RD
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:MI
Practice Address - Zip Code:48428-9329
Practice Address - Country:US
Practice Address - Phone:517-712-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276634163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse