Provider Demographics
NPI:1467277582
Name:LINDBERG, COURTENEY ELIZABETH ADA
Entity type:Individual
Prefix:
First Name:COURTENEY
Middle Name:ELIZABETH ADA
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 IRENE CT
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-3700
Mailing Address - Country:US
Mailing Address - Phone:508-450-9642
Mailing Address - Fax:
Practice Address - Street 1:101 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2463
Practice Address - Country:US
Practice Address - Phone:508-853-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAX363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily