Provider Demographics
NPI:1124022165
Name:LINDSTROM, THERESA E (PA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:E
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 W CHANDLER BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3342
Mailing Address - Country:US
Mailing Address - Phone:480-776-0440
Mailing Address - Fax:480-776-0444
Practice Address - Street 1:5680 W CHANDLER BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3342
Practice Address - Country:US
Practice Address - Phone:480-776-0440
Practice Address - Fax:480-776-0444
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2295363LP0200X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics