Provider Demographics
NPI:1376069682
Name:LINDSAY, AUTUMN (MD, LPN)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:LINDSAY
Suffix:
Gender:F
Credentials:MD, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2603
Mailing Address - Country:US
Mailing Address - Phone:419-251-1860
Mailing Address - Fax:419-251-7824
Practice Address - Street 1:2213 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1402
Practice Address - Country:US
Practice Address - Phone:419-251-2415
Practice Address - Fax:419-251-2422
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4703118320164X00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse