Provider Demographics
NPI:1225463789
Name:JOHNSON, LINDSEY R (CNM)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:R
Other - Last Name:TOLLEFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 N 51ST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2867
Mailing Address - Country:US
Mailing Address - Phone:402-932-8020
Mailing Address - Fax:402-905-3042
Practice Address - Street 1:119 N 51ST ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2867
Practice Address - Country:US
Practice Address - Phone:402-932-8020
Practice Address - Fax:402-905-3042
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF135264363L00000X
NE111594207V00000X, 363L00000X
IAB135264367A00000X
NE120054367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife