Provider Demographics
NPI:1619242690
Name:LINDAUER, GREGORY PAUL (APRN)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:PAUL
Last Name:LINDAUER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E GRAY ST
Mailing Address - Street 2:TB CLINIC
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1740
Mailing Address - Country:US
Mailing Address - Phone:502-574-6617
Mailing Address - Fax:502-574-8666
Practice Address - Street 1:400 E GRAY ST
Practice Address - Street 2:TB CLINIC
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1740
Practice Address - Country:US
Practice Address - Phone:502-574-6617
Practice Address - Fax:502-574-8666
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100195610Medicaid
KY7100195610Medicaid