Provider Demographics
NPI:1437895505
Name:LINDSTROM, VICKI LEA
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LEA
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15129 CASTLE WAY
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-8253
Mailing Address - Country:US
Mailing Address - Phone:208-249-9031
Mailing Address - Fax:
Practice Address - Street 1:15129 CASTLE WAY
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-8253
Practice Address - Country:US
Practice Address - Phone:208-249-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No385H00000XRespite Care FacilityRespite Care