Provider Demographics
NPI:1992349641
Name:PINE, LINDSEY ANDERSON
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ANDERSON
Last Name:PINE
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 1:1431 LOG CABIN RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERDAM
Mailing Address - State:VA
Mailing Address - Zip Code:23015-9505
Mailing Address - Country:US
Mailing Address - Phone:804-956-5284
Mailing Address - Fax:
Practice Address - Street 1:1431 LOG CABIN RD
Practice Address - Street 2:
Practice Address - City:BEAVERDAM
Practice Address - State:VA
Practice Address - Zip Code:23015-9505
Practice Address - Country:US
Practice Address - Phone:804-956-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider