Provider Demographics
NPI:1194275834
Name:LINDSAY, JEREMY
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:LINDSAY
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 1:15268 S DIXIE HWY
Mailing Address - Street 2:3
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-5040
Mailing Address - Country:US
Mailing Address - Phone:734-240-0520
Mailing Address - Fax:
Practice Address - Street 1:15268 S DIXIE HWY
Practice Address - Street 2:3
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-5040
Practice Address - Country:US
Practice Address - Phone:734-240-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704301248163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse