Provider Demographics
NPI:1477930287
Name:LINDGREN LASSITER, MIRIAM FRANCES
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:FRANCES
Last Name:LINDGREN LASSITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:FRANCES
Other - Last Name:LASSITER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4239 VIA ARBOLADA
Mailing Address - Street 2:UNIT 314
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5097
Mailing Address - Country:US
Mailing Address - Phone:323-708-9577
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-1042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program