Provider Demographics
NPI:1578063335
Name:BUKOWSKI, LINDSAY MARIE (CRNP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MARIE
Last Name:BUKOWSKI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 BOULEVARD AVE
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1729
Mailing Address - Country:US
Mailing Address - Phone:570-877-4846
Mailing Address - Fax:
Practice Address - Street 1:315 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1790
Practice Address - Country:US
Practice Address - Phone:570-457-8364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily