Provider Demographics
NPI:1710969159
Name:LINDQUIST, MATTHEW P (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:P
Last Name:LINDQUIST
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5000 CEDAR PLAZA PARKWAY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128
Mailing Address - Country:US
Mailing Address - Phone:314-843-4333
Mailing Address - Fax:314-843-4856
Practice Address - Street 1:5000 CEDAR PLAZA PARKWAY
Practice Address - Street 2:SUITE 350
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:314-843-4333
Practice Address - Fax:314-843-4856
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146028363L00000X, 363LP0808X
IL041238461363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO826373362Medicare ID - Type Unspecified