Provider Demographics
NPI:1548690639
Name:LINDSTROM, LISA (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3729 N PERSHING DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-3518
Mailing Address - Country:US
Mailing Address - Phone:703-408-1794
Mailing Address - Fax:
Practice Address - Street 1:1924 SAVANNAH TER SE APT C
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2148
Practice Address - Country:US
Practice Address - Phone:202-923-8068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1003666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily