Provider Demographics
NPI:1447776505
Name:ANDRADE, LINDSEY RAE (FNP-BC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:RAE
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:RAE
Other - Last Name:MANIATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12975 N 149TH DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-6903
Mailing Address - Country:US
Mailing Address - Phone:702-525-8312
Mailing Address - Fax:
Practice Address - Street 1:20401 N 73RD ST STE 230
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4153
Practice Address - Country:US
Practice Address - Phone:480-556-0446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2023-05-31
Deactivation Date:2023-04-20
Deactivation Code:
Reactivation Date:2023-05-26
Provider Licenses
StateLicense IDTaxonomies
CA95075469163W00000X
NVRN90196163W00000X
AZRN159404163W00000X
AZ289753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD01782280OtherDRIVERS LICENSE