Provider Demographics
NPI:1053780973
Name:BROUGH, LINDSEY N (FNP-C)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:N
Last Name:BROUGH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CONNIE AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-2305
Mailing Address - Country:US
Mailing Address - Phone:812-404-4235
Mailing Address - Fax:
Practice Address - Street 1:101 CONNIE AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-2305
Practice Address - Country:US
Practice Address - Phone:812-404-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005811A363LP0200X, 363LF0000X
IN28155343A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics