Provider Demographics
NPI:1730175712
Name:LINDSTROM, MARCELLA A (APRN, CNP)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:A
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:A
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 EASTLAND DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3534
Mailing Address - Country:US
Mailing Address - Phone:309-665-4040
Mailing Address - Fax:309-664-3350
Practice Address - Street 1:1505 EASTLAND DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3534
Practice Address - Country:US
Practice Address - Phone:309-665-4040
Practice Address - Fax:309-664-3350
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000302363LF0000X
IL041279589363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL562330Medicare PIN