Provider Demographics
NPI:1174930754
Name:BIRK, LINDSEY M
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:M
Last Name:BIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:MARIE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 W MORTON AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-4021
Mailing Address - Country:US
Mailing Address - Phone:217-588-6140
Mailing Address - Fax:217-588-3043
Practice Address - Street 1:901 W MORTON AVE STE 22
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-4021
Practice Address - Country:US
Practice Address - Phone:217-588-6140
Practice Address - Fax:217-588-3043
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-015903363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041382331OtherRN LICENSE