Provider Demographics
NPI:1922093129
Name:LINDSTROM, TRISHA M (CPNP)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:M
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:M
Other - Last Name:MCNAMARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:1684 FOOTE AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-9385
Mailing Address - Country:US
Mailing Address - Phone:716-661-9730
Mailing Address - Fax:716-661-9732
Practice Address - Street 1:1684 FOOTE AVENUE EXT
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-9385
Practice Address - Country:US
Practice Address - Phone:716-661-9730
Practice Address - Fax:716-661-9732
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381437-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00027253801OtherUNIVERA HEALTHCARE/EXCELL
NY161570481OtherCOMMERCIAL INSURANCE