Basic Information
Provider Information
NPI: 1871865683
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LINDSEY
FirstName: SARAH
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: CNS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8940 N WOOD SAGE RD
Address2:  
City: PEORIA
State: IL
PostalCode: 616157822
CountryCode: US
TelephoneNumber: 3092433000
FaxNumber: 3092433215
Practice Location
Address1: 8940 N WOOD SAGE RD
Address2:  
City: PEORIA
State: IL
PostalCode: 616157822
CountryCode: US
TelephoneNumber: 3092433000
FaxNumber: 3092433215
Other Information
ProviderEnumerationDate: 02/09/2012
LastUpdateDate: 04/09/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
364SA2200X209.007306ILY Physician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health

No ID Information.


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