Provider Demographics
NPI:1104359033
Name:LINDOW, MISTY
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:LINDOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SILVER LEAF DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8317
Mailing Address - Country:US
Mailing Address - Phone:815-375-0157
Mailing Address - Fax:
Practice Address - Street 1:701 SILVER LEAF DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8317
Practice Address - Country:US
Practice Address - Phone:815-375-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide