1285871277 NPI number — SANDRA ROSWITHA LINDELL PMHNP-BC

Table of content: SANDRA ROSWITHA LINDELL PMHNP-BC (NPI 1285871277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285871277 NPI number — SANDRA ROSWITHA LINDELL PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINDELL
Provider First Name:
SANDRA
Provider Middle Name:
ROSWITHA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285871277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8609 LYNDALE AVE S
Provider Second Line Business Mailing Address:
SUITE 201-C
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-285-2144
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 SLEATER KINNEY RD SW CENTER OF MINDFUL HEALING
Provider Second Line Business Practice Location Address:
STE B-169
Provider Business Practice Location Address City Name:
LACEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-972-7855
Provider Business Practice Location Address Fax Number:
360-282-1095
Provider Enumeration Date:
01/13/2009

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: 363LP0808X , with the licence number:  R1676611 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: NP1682 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X , with the licence number: AP61135817 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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