Individual provider Active NPI

Theresa E Lindstrom, PA

  • Physician Assistant
  • Chandler, AZ
National Provider Identifier
1124022165
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2295 Issued in AZ
Practice address
5680 W Chandler Blvd Ste 3
Chandler, AZ 85226-3342
Phone
(480) 776-0440
Fax
(480) 776-0444
NPI assigned
Jun 8, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 2295 AZ
Physician Assistant 363A00000X 2295 AZ Primary

Addresses

Primary practice location

5680 W Chandler Blvd Ste 3
Chandler, AZ 85226-3342

Mailing address

5680 W Chandler Blvd Ste 3
Chandler, AZ 85226-3342
Phone (480) 776-0440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2295AZMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Step by Step Pediatrics CurrentSince Oct 29, 2023 Accepting new patients

Locations

5680 W Chandler Blvd
Ste 3
Chandler, AZ 85226
Phone (480) 776-0440

4633 E Chandler Blvd
Ste 100
Phoenix, AZ 85048
Phone (480) 776-0440

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1124022165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5680 W CHANDLER BLVD STE 3",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852263342",
            "telephone_number": "480-776-0440",
            "fax_number": "480-776-0444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5680 W CHANDLER BLVD STE 3",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852263342",
            "telephone_number": "480-776-0440",
            "fax_number": "480-776-0444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LINDSTROM",
        "first_name": "THERESA",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-08",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AZ",
            "license": "2295",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.