Provider Demographics
NPI:1104882828
Name:NELL, LINDSEY E (PAC)
Entity type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:E
Last Name:NELL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-3371
Mailing Address - Country:US
Mailing Address - Phone:814-726-3310
Mailing Address - Fax:814-723-1338
Practice Address - Street 1:143 PLEASANT DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365
Practice Address - Country:US
Practice Address - Phone:814-726-3310
Practice Address - Fax:814-726-0295
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052235363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q63833Medicare UPIN
PA098462D6JMedicare ID - Type Unspecified