Provider Demographics
NPI:1912624404
Name:LINDGREN, ALLYSON KAY (APRN)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:KAY
Last Name:LINDGREN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:KAY
Other - Last Name:LINDGREN PIERRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4307 CRESTON DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-9342
Mailing Address - Country:US
Mailing Address - Phone:217-369-5732
Mailing Address - Fax:
Practice Address - Street 1:2043 S NEIL ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7219
Practice Address - Country:US
Practice Address - Phone:217-337-3852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026239363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner