Provider Demographics
NPI:1730413113
Name:MAUDRIE, LINDSAY (PA)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:
Last Name:MAUDRIE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:FELDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:P,A
Mailing Address - Street 1:995 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-3861
Mailing Address - Country:US
Mailing Address - Phone:434-284-3100
Mailing Address - Fax:734-284-8212
Practice Address - Street 1:995 FORD AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-3861
Practice Address - Country:US
Practice Address - Phone:734-284-3100
Practice Address - Fax:734-284-8212
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005604363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION11710Medicare PIN
MIL2298113Medicare UPIN