1235579004 NPI number — LINDSAY D'AMICO NELSON ANP

Table of content: (NPI 1891198610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235579004 NPI number — LINDSAY D'AMICO NELSON ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
LINDSAY
Provider Middle Name:
D'AMICO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMIK
Provider Other First Name:
LINDSAY
Provider Other Middle Name:
D'AMICO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ANP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235579004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2551 W 84TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80031-3807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-561-5010
Provider Business Mailing Address Fax Number:
303-561-5050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PEACEHEALTH MEDICAL GROUP
Provider Second Line Business Practice Location Address:
3301 SQUALICUM PARKWAY
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-788-8222
Provider Business Practice Location Address Fax Number:
360-788-7759
Provider Enumeration Date:
06/26/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  N360959388 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: APN.0993042-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 1422 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1610433 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".