Provider Demographics
NPI:1548380264
Name:VANDEVOORDE, LINDIE (LAC)
Entity Type:Individual
Prefix:
First Name:LINDIE
Middle Name:
Last Name:VANDEVOORDE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N22W27847 EDGEWATER DR
Mailing Address - Street 2:SUITE #102
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5227
Mailing Address - Country:US
Mailing Address - Phone:262-264-0080
Mailing Address - Fax:
Practice Address - Street 1:N22W27847 EDGEWATER DR
Practice Address - Street 2:SUITE #102
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5227
Practice Address - Country:US
Practice Address - Phone:262-264-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2552-046171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist