Provider Demographics
NPI:1194882993
Name:GOUWENS, LINDSEY (PAC)
Entity type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:
Last Name:GOUWENS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:CASHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:2940 ROLLINGRIDGE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4231
Mailing Address - Country:US
Mailing Address - Phone:630-579-6500
Mailing Address - Fax:630-579-5860
Practice Address - Street 1:2940 ROLLINGRIDGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4231
Practice Address - Country:US
Practice Address - Phone:630-579-6500
Practice Address - Fax:630-579-5860
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002852363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK40975OtherMEDICARE PROVIDER NUMBER
IL212204Medicare PIN