1568628493 NPI number — AMBUR MARIE LINDSTROM-METTE FNP

Table of content: AMBUR MARIE LINDSTROM-METTE FNP (NPI 1568628493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568628493 NPI number — AMBUR MARIE LINDSTROM-METTE FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINDSTROM-METTE
Provider First Name:
AMBUR
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINDSTROM
Provider Other First Name:
AMBUR
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568628493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARANA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85653-0188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-682-4560
Provider Business Mailing Address Fax Number:
520-682-4570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6524 E CARONDELET DR
Provider Second Line Business Practice Location Address:
BLDGE D
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85710-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-290-1100
Provider Business Practice Location Address Fax Number:
520-290-8997
Provider Enumeration Date:
07/30/2008

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:  AP3110 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: RN119218 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 352424 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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