Provider Demographics
NPI:1417375304
Name:LINDSAY, MARK (NP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LINDSAY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1387 ELM ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2514
Mailing Address - Country:US
Mailing Address - Phone:717-421-2312
Mailing Address - Fax:
Practice Address - Street 1:12801 E 17TH AVE
Practice Address - Street 2:ROOM 7103
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2530
Practice Address - Country:US
Practice Address - Phone:717-421-2312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991135-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health