Provider Demographics
NPI:1689257255
Name:BANGE, LYNDSIE NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:LYNDSIE
Middle Name:NICOLE
Last Name:BANGE
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 1:140 VILLAGE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6436
Mailing Address - Country:US
Mailing Address - Phone:205-980-1744
Mailing Address - Fax:205-980-1334
Practice Address - Street 1:140 VILLAGE ST STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6436
Practice Address - Country:US
Practice Address - Phone:205-980-1744
Practice Address - Fax:205-980-1334
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN268868363LF0000X
AL1-168624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily