Provider Demographics
NPI:1821873126
Name:MOTTERN, LINDSEY JAYNE (FNP)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:JAYNE
Last Name:MOTTERN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 EL CAMINO REAL UNIT 1111
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2478
Mailing Address - Country:US
Mailing Address - Phone:863-581-2153
Mailing Address - Fax:
Practice Address - Street 1:261 EL CAMINO REAL UNIT 1111
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2478
Practice Address - Country:US
Practice Address - Phone:863-581-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2023019174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily