Provider Demographics
NPI:1366405391
Name:LINDSTROM, KAREN PATRICIA (LPN,RN)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:PATRICIA
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:LPN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54015-4501
Mailing Address - Country:US
Mailing Address - Phone:715-796-5353
Mailing Address - Fax:
Practice Address - Street 1:1853 120TH AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:WI
Practice Address - Zip Code:54015-4501
Practice Address - Country:US
Practice Address - Phone:715-796-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38297700Medicaid