Provider Demographics
NPI:1659837722
Name:VONDERAHE, LINDSAY NICHOLE (APRN)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:NICHOLE
Last Name:VONDERAHE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 SHELBYVILLE RD STE 530
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5149
Mailing Address - Country:US
Mailing Address - Phone:502-953-4799
Mailing Address - Fax:
Practice Address - Street 1:1621 NASHVILLE ST STE 106
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8871
Practice Address - Country:US
Practice Address - Phone:270-946-1372
Practice Address - Fax:270-216-6185
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF02190797363L00000X
KY3014255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF02190797OtherAANP