Provider Demographics
NPI:1093243339
Name:PEDERSON, LINDSEY MACIEL (APN)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:MACIEL
Last Name:PEDERSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 W ERIE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-6019
Mailing Address - Country:US
Mailing Address - Phone:815-735-1140
Mailing Address - Fax:
Practice Address - Street 1:60 E DELAWARE PL STE 1420
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1495
Practice Address - Country:US
Practice Address - Phone:312-440-5127
Practice Address - Fax:312-440-5127
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015924363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner