Provider Demographics
NPI:1811757453
Name:LINDSAY, MARK (FNP-BC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LINDSAY
Suffix:
Gender:M
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 1:2601 N MARY JANE LN
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-1128
Mailing Address - Country:US
Mailing Address - Phone:928-699-9643
Mailing Address - Fax:
Practice Address - Street 1:2601 N MARY JANE LN
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-1128
Practice Address - Country:US
Practice Address - Phone:928-699-9643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ305247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine