Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 209015554 | IL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 30056 | TN |
NPI | 1003353848 |
---|---|
Provider Name | Lindsey N Pietsek |
First Address | Springfield, IL 62708-3428 |
Second Address | Springfield, IL 62769-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2017 |
Last Update Date | 06/10/2021 |