Provider Demographics
NPI:1629604087
Name:LINDBERG, JACKIE LEA (DNP, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:LEA
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:LEA
Other - Last Name:HILLSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:417 SKYLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1164
Mailing Address - Country:US
Mailing Address - Phone:218-879-1271
Mailing Address - Fax:218-879-9617
Practice Address - Street 1:417 SKYLINE BLVD
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1164
Practice Address - Country:US
Practice Address - Phone:218-879-1271
Practice Address - Fax:218-879-9617
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8742363LF0000X
MN1851517163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical