Provider Demographics
NPI:1376806646
Name:LOVENDAHL, MINDY SUE (APRN)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:SUE
Last Name:LOVENDAHL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:SUE
Other - Last Name:TREMBLAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:520 S. SANTA FE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401
Mailing Address - Country:US
Mailing Address - Phone:785-823-7470
Mailing Address - Fax:785-823-4356
Practice Address - Street 1:520 S. SANTA FE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-823-7470
Practice Address - Fax:785-823-4356
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75682363LF0000X
KS1387344012363LF0000X
KS5375682012363LF0000X
KS5375682363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200876720EMedicaid