Provider Demographics
NPI:1962507947
Name:LINDSAY, LISA M (CNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:LINDSAY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 N BAXTER RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-8104
Mailing Address - Country:US
Mailing Address - Phone:810-785-4034
Mailing Address - Fax:810-787-3254
Practice Address - Street 1:2281 N BAXTER RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-8104
Practice Address - Country:US
Practice Address - Phone:810-785-4034
Practice Address - Fax:810-787-3254
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196224363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4511663Medicaid
MI5008701230OtherBLUE SHIELD
MI4511663Medicaid
MIP83961Medicare UPIN