Provider Demographics
NPI:1881131894
Name:ZAJAC, LYNDSEY
Entity type:Individual
Prefix:MRS
First Name:LYNDSEY
Middle Name:
Last Name:ZAJAC
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LYNDSEY
Other - Middle Name:MICHELLE
Other - Last Name:HEAVRIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1701 SPRING ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-2930
Mailing Address - Country:US
Mailing Address - Phone:812-284-2273
Mailing Address - Fax:812-284-2279
Practice Address - Street 1:1701 SPRING ST
Practice Address - Street 2:SUITE B
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-2930
Practice Address - Country:US
Practice Address - Phone:812-284-2273
Practice Address - Fax:812-284-2279
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006843A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001075147OtherANTHEM
IN300000766Medicaid
INP01808037Medicare PIN
IN264050007Medicare PIN