Provider Demographics
NPI:1124768072
Name:LINDGREN, LARAMIE
Entity type:Individual
Prefix:
First Name:LARAMIE
Middle Name:
Last Name:LINDGREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2154
Mailing Address - Country:US
Mailing Address - Phone:402-443-2023
Mailing Address - Fax:
Practice Address - Street 1:1230 E PIERCE ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4747
Practice Address - Country:US
Practice Address - Phone:712-328-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program