Provider Demographics
NPI:1902256696
Name:NISSENBAUM, LINDSEY M (MD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:M
Last Name:NISSENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:M
Other - Last Name:VAN SAMBEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:232 S WOODS MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3406
Mailing Address - Country:US
Mailing Address - Phone:314-205-6990
Mailing Address - Fax:
Practice Address - Street 1:232 S WOODS MILL RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3406
Practice Address - Country:US
Practice Address - Phone:314-205-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019005009207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine