Provider Demographics
NPI:1538821046
Name:HARGIS, LINDSAY BLAIR (CPNP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:BLAIR
Last Name:HARGIS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:BLAIR
Other - Last Name:HOLDWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21237 BAYSIDE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1198
Mailing Address - Country:US
Mailing Address - Phone:586-438-0172
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2196
Practice Address - Country:US
Practice Address - Phone:313-745-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704315183363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics