Provider Demographics
NPI:1972834372
Name:LINDEQUE, DOMINIC (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:LINDEQUE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 NEWBURY ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:677 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6043
Practice Address - Country:US
Practice Address - Phone:414-241-6954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 11300-NP207P00000X
OH11300-NP363LF0000X
IN71004045A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201100500Medicaid
OH3047849Medicaid
INP01424374OtherMEDICARE RAILROAD PTAN
OH3047849Medicaid
IN267030007Medicare PIN
IN266180407Medicare PIN
INP01202357Medicare PIN