Provider Demographics
NPI:1982039244
Name:ROBERTSON, LINDSEY D (NP)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:D
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N MERIDIAN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1077
Mailing Address - Country:US
Mailing Address - Phone:317-962-4941
Mailing Address - Fax:317-962-4950
Practice Address - Street 1:714 N SENATE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3763
Practice Address - Country:US
Practice Address - Phone:317-715-6402
Practice Address - Fax:317-715-6415
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004601A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201199640Medicaid
IN959090008Medicare PIN