Provider Demographics
NPI:1912941097
Name:LINDQUIST, MARY P (CRNA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:LINDQUIST
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W LAKE MEAD PKWY
Mailing Address - Street 2:SUITE B18
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-6954
Mailing Address - Country:US
Mailing Address - Phone:702-564-4440
Mailing Address - Fax:702-558-1522
Practice Address - Street 1:129 W LAKE MEAD PKWY
Practice Address - Street 2:SUITE B18
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-6954
Practice Address - Country:US
Practice Address - Phone:702-564-4440
Practice Address - Fax:702-558-1522
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCRNA000383367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCRNA000383OtherSTATE NURSING LICENSE
NVRN68312OtherSTATE NURSING LICENSE