Provider Demographics
NPI:1902144496
Name:SULLIVAN, LINDSAY TEMPEL (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:TEMPEL
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:ANNE
Other - Last Name:TEMPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-718-7041
Mailing Address - Fax:336-718-9622
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-7041
Practice Address - Fax:336-718-9622
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012456363LA2100X
NC5009373363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care