Provider Demographics
NPI:1518316983
Name:LINDSTROM, GABRIEL (FNP)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:LINDSTROM
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MOHAVE DR
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-9796
Mailing Address - Country:US
Mailing Address - Phone:520-559-2695
Mailing Address - Fax:
Practice Address - Street 1:6911 N BDI BLVD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-6202
Practice Address - Country:US
Practice Address - Phone:520-364-7521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP8682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily