Provider Demographics
NPI:1619771961
Name:LINDEBERG, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LINDEBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5248 SUMMER TROUT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-6615
Mailing Address - Country:US
Mailing Address - Phone:702-201-5175
Mailing Address - Fax:
Practice Address - Street 1:5248 SUMMER TROUT ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-6615
Practice Address - Country:US
Practice Address - Phone:702-201-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant