Provider Demographics
NPI:1053093963
Name:IANNONE, LINDSAY ROSE (PA-C, MSPAS)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ROSE
Last Name:IANNONE
Suffix:
Gender:F
Credentials:PA-C, MSPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 1ST ST SE STE 110
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-9301
Mailing Address - Country:US
Mailing Address - Phone:541-347-2529
Mailing Address - Fax:541-347-9196
Practice Address - Street 1:1010 1ST ST SE STE 110
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9301
Practice Address - Country:US
Practice Address - Phone:541-347-2529
Practice Address - Fax:541-347-9196
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA220451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant