Provider Demographics
NPI:1740748284
Name:LINDGREN, KERRY ELLEN (RN,PHN, CREDSCHNURSE)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ELLEN
Last Name:LINDGREN
Suffix:
Gender:F
Credentials:RN,PHN, CREDSCHNURSE
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:ELLEN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:930 WESTACRE RD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3224
Mailing Address - Country:US
Mailing Address - Phone:916-588-8382
Mailing Address - Fax:
Practice Address - Street 1:930 WESTACRE RD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3224
Practice Address - Country:US
Practice Address - Phone:916-588-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA790772163W00000X
CA180017457163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse