Provider Demographics
NPI:1871975185
Name:VAN DUYN, LINDSEY (DO)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:VAN DUYN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 S STUART ST STE B
Mailing Address - Street 2:
Mailing Address - City:SIGOURNEY
Mailing Address - State:IA
Mailing Address - Zip Code:52591-1154
Mailing Address - Country:US
Mailing Address - Phone:641-622-1170
Mailing Address - Fax:
Practice Address - Street 1:1314 S STUART ST STE B
Practice Address - Street 2:
Practice Address - City:SIGOURNEY
Practice Address - State:IA
Practice Address - Zip Code:52591-1154
Practice Address - Country:US
Practice Address - Phone:641-622-1170
Practice Address - Fax:641-903-7024
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA05209208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAPENDINGMedicaid