Provider Demographics
NPI:1437466323
Name:KOELMAN, LINDSEY HAYES (LAC)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:HAYES
Last Name:KOELMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:ALLISON
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:41 MADRONE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2013
Mailing Address - Country:US
Mailing Address - Phone:415-407-0528
Mailing Address - Fax:
Practice Address - Street 1:124 PINE ST
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2602
Practice Address - Country:US
Practice Address - Phone:415-407-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13456171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist