Provider Demographics
NPI:1326481847
Name:LINDENBORN, BRIAN (CRNA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LINDENBORN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-0960
Mailing Address - Country:US
Mailing Address - Phone:231-480-4668
Mailing Address - Fax:231-480-4736
Practice Address - Street 1:1 N ATKINSON DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1906
Practice Address - Country:US
Practice Address - Phone:231-480-4668
Practice Address - Fax:231-480-4736
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS146682367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110385Medicare Oscar/Certification