Provider Demographics
NPI:1376565705
Name:LINDNER, ELIZABETH A (PHD, APNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:LINDNER
Suffix:
Gender:F
Credentials:PHD, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N 6326 RAVEN ROAD
Mailing Address - Street 2:
Mailing Address - City:PARDEEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53954
Mailing Address - Country:US
Mailing Address - Phone:608-333-9030
Mailing Address - Fax:877-765-0576
Practice Address - Street 1:1250 FEMRITE DR #205
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716
Practice Address - Country:US
Practice Address - Phone:608-333-9030
Practice Address - Fax:608-752-9699
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1042-33103T00000X, 363LP0808X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39400600Medicaid
WI000984706Medicare PIN
WI27929Medicare PIN