Provider Demographics
NPI:1821356916
Name:LINDSTROM, HOLLY RAE (RN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:RAE
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9218 KIMMER DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6732
Mailing Address - Country:US
Mailing Address - Phone:720-763-9017
Mailing Address - Fax:720-763-9027
Practice Address - Street 1:9218 KIMMER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6732
Practice Address - Country:US
Practice Address - Phone:720-763-9017
Practice Address - Fax:720-763-9027
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-97708163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse