Provider Demographics
NPI:1992474787
Name:LINDEMANN, LATASHA RENEE (WHNP)
Entity type:Individual
Prefix:MRS
First Name:LATASHA
Middle Name:RENEE
Last Name:LINDEMANN
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35103 EVANSTON AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3840
Mailing Address - Country:US
Mailing Address - Phone:313-318-2789
Mailing Address - Fax:
Practice Address - Street 1:35103 EVANSTON AVE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3840
Practice Address - Country:US
Practice Address - Phone:313-318-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704295560NSA2310J367A00000X
MI4704295560363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4074295560Medicaid