Provider Demographics
NPI:1477815769
Name:VOGEL, LINDSAY R (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:R
Last Name:VOGEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4543
Mailing Address - Country:US
Mailing Address - Phone:319-833-5830
Mailing Address - Fax:319-833-5831
Practice Address - Street 1:1717 W RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4543
Practice Address - Country:US
Practice Address - Phone:319-833-5830
Practice Address - Fax:319-833-5831
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAJ111205363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1477815769Medicaid
IA719260505Medicare UPIN