Provider Demographics
NPI:1922525328
Name:NEUTKENS, LINDSAY MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MARIE
Last Name:NEUTKENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:MARIE
Other - Last Name:ORTLIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15700 37TH AVE N STE 150
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3675
Practice Address - Country:US
Practice Address - Phone:651-968-5201
Practice Address - Fax:651-968-5903
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4493363A00000X, 363AS0400X
MN12557363A00000X
WI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant