Provider Demographics
NPI:1487479762
Name:LINDO, GINA
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:LINDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12024 NW 136TH TER
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-9174
Mailing Address - Country:US
Mailing Address - Phone:405-657-6297
Mailing Address - Fax:
Practice Address - Street 1:12024 NW 136TH TER
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-9174
Practice Address - Country:US
Practice Address - Phone:405-657-6297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK080809653343900000X
OKW080809653343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)