Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 264846 | NY |
Y | 207SG0201X | Clinical Genetics (M.D.) | 49590 | AZ |
N | 208000000X | Pediatrician | 046719 | CT |
N | 208000000X | Pediatrician | 264846 | NY |
NPI | 1306023593 |
---|---|
Provider Name | Kristin E Lindstrom |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85006-1464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2008 |
Last Update Date | 23/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03463421 | (05) | NY |