Provider Demographics
NPI:1437447802
Name:ANDERSON, LINDSAY RYAN (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:RYAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 PFINGSTEN RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1301
Mailing Address - Country:US
Mailing Address - Phone:847-657-5800
Mailing Address - Fax:847-657-3724
Practice Address - Street 1:9000 WAUKEGAN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2127
Practice Address - Country:US
Practice Address - Phone:847-967-5122
Practice Address - Fax:847-967-5125
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004066363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant