Provider Demographics
NPI:1972140796
Name:WITHAM, LINDSEY BROOKE (APRN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:BROOKE
Last Name:WITHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:BROOKE
Other - Last Name:COFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:268 SOUNDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-2137
Mailing Address - Country:US
Mailing Address - Phone:203-954-5271
Mailing Address - Fax:
Practice Address - Street 1:268 SOUNDVIEW AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-2137
Practice Address - Country:US
Practice Address - Phone:203-954-5271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-01
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2019071921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily