Provider Demographics
NPI:1659840767
Name:VAN DAM, LINDSAY K (NP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:K
Last Name:VAN DAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 E ARBOR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6102
Mailing Address - Country:US
Mailing Address - Phone:480-985-1700
Mailing Address - Fax:480-396-3659
Practice Address - Street 1:6020 E ARBOR AVE STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6102
Practice Address - Country:US
Practice Address - Phone:480-985-1700
Practice Address - Fax:480-396-3659
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN166378163W00000X
AZ220794363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN166378OtherNURSING LICENSE
AZ220794OtherNURSE PRACTITIONER