Provider Demographics
NPI:1134553563
Name:LANDIS, LINDSAY MARIE (NP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MARIE
Last Name:LANDIS
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 1:564 EAST SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2914
Mailing Address - Country:US
Mailing Address - Phone:330-482-9350
Mailing Address - Fax:330-332-7915
Practice Address - Street 1:564 EAST SECOND STREET
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2914
Practice Address - Country:US
Practice Address - Phone:330-482-9350
Practice Address - Fax:330-332-7915
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX810470363LF0000X
OHCOA.16858-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0126237Medicaid