Provider Demographics
NPI:1396397220
Name:PASTORIK, LINDSEY (APN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:PASTORIK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10408 N CENTERWAY DR STE CDE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1234
Mailing Address - Country:US
Mailing Address - Phone:309-308-5100
Mailing Address - Fax:309-308-5101
Practice Address - Street 1:10408 N CENTERWAY DR STE CDE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1234
Practice Address - Country:US
Practice Address - Phone:309-308-5100
Practice Address - Fax:309-308-5101
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019588363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner