MS. CAROL LYNN LIDSTROM (NPI# 1700192424) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700192424 |
| Entity Type | Individual |
| Full Name | MS. CAROL LYNN LIDSTROM |
| Credential | PA-C |
| Practice Address |
1 Ford Pl Suite 2e Detroit MI 48202-3450 |
| Mailing Address |
3139 S Wayne Rd Wayne MI 48184-1220 |
| Practice Telephone | 3139373049 |
| Mailing Telephone | 7347222722 |
| Mailing Fax Number | 7347227006 |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2010-08-19 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
5601002244 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982724357 | Carol Frances Lidstrom | Psychiatry & Neurology | 105 West Main Street, Suite One, Littleton, NH 03561 | 2007-03-30 |
| Street Address |
1 FORD PL SUITE 2E |
| City | DETROIT |
| State | MI |
| Zip Code | 48202-3450 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447241229 | Mary Hicks | Nurse Practitioner | 1 Ford Pl, Detroit, MI 48202 | 2005-11-02 |
| 1548870769 | Robert Devore | Nurse Practitioner | 1 Ford Pl, Detroit, MI 48202-3450 | 2020-08-03 |
| 1740831668 | Sarah Anna Moore | Social Worker | 1 Ford Pl, Detroit, MI 48202-3450 | 2019-09-23 |
| 1043863897 | Bethany Thayer | Dietitian, Registered | 1 Ford Pl, Detroit, MI 48202-3450 | 2019-07-22 |
| 1609380328 | Tanesha Lowery | Nurse Practitioner | 1 Ford Pl, Detroit, MI 48202-3450 | 2017-11-17 |
| 1972012904 | Alaina Grace Esposito | Social Worker | 1 Ford Pl, Detroit, MI 48202-3450 | 2017-09-21 |
| 1780107029 | Kellie Martens | Psychologist | 1 Ford Pl, Detroit, MI 48202-3450 | 2017-07-19 |
| 1164956538 | Shaelyn Nicole Gurzick | Dietitian, Registered | 1 Ford Pl, Suite 5c, Detroit, MI 48202-3450 | 2017-04-12 |
| 1093251878 | Chinwe Obioha | Nurse Practitioner | 1 Ford Pl, Detroit, MI 48202-3450 | 2017-01-17 |
| 1881142115 | Ivory Villanueva Fulgencio | Nurse Anesthetist, Certified Registered | 1 Ford Pl, Ste 2e, Detroit, MI 48202-3450 | 2016-09-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710584602 | Andrea Irene Martin | Audiologist | 2799 E Grand Blvd, Detroit, MI 48202 | 2020-10-05 |
| 1174132583 | Odei Alayyas | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Boulevard Henry Ford Hospital, Medical Ed, Detroit, MI 48202 | 2020-07-31 |
| 1912529801 | Aroob Nabil Nimer Sweidan | Student in an Organized Health Care Education/Training Program | 2799 West Grand Boulvard, Department of Internal Meidicine, Cfp 1, Detroit, MI 48202 | 2020-05-13 |
| 1306485636 | Katie Burlen-davis | Registered Nurse | 9045 Woodward Ave, Detroit, MI 48202 | 2020-01-03 |
| 1407401250 | Santhalakshmi Angappan | Student in an Organized Health Care Education/Training Program | Henry Ford Hospital Medical Education Department, 2799 W. Grand Boulevard, Detroit, MI 48202 | 2019-08-08 |
| 1851945687 | Walter Mitini Etoh | Nurse Practitioner | Henry Ford Hospital I1 Observation, 2799 W. Grand Blvd, Detroit, MI 48202 | 2019-07-30 |
| 1467913756 | Andrew Michael Schock | Emergency Medicine | Ceci Murrell-harvey, Henry Ford Hospital, 2799 W. Grand. Blvd, Cfp 046, Detroit, MI 48202 | 2019-03-28 |
| 1700363892 | Zaid Al-saheli | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvdl, Cfp 046, Hope Peck, Detroit, MI 48202 | 2018-07-23 |
| 1932690096 | Yusuf Naser Alalwan | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvd. Henry Ford Hospital - Gme Office, Detroit, MI 48202 | 2018-05-24 |
| 1568952729 | Kelvin Sellers | Massage Therapist | 832 Seward, Detriot, MI 48202 | 2018-05-14 |
| Find all providers in zip 48202 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831340355 | Antonia L Navarro | Physician Assistant | University Physician Group Oncology, 4100 John R, Detroit, MI 48201-2013 | 2008-10-02 |
| 1104974443 | Amy B Oatfield | Physician Assistant | Henry Ford Hospital Trauma and Critical Care Cfp-1, 2799 West Grand Blvd, Detroit, MI 48202 | 2007-01-05 |
| 1295750677 | Ingrid Dominic Mitchell | Physician Assistant | 18254 Livernois Ave Ste 1, Detroit, MI 48221-4214 | 2006-07-13 |
| 1952397291 | Kelly Michelle Brown | Physician Assistant | 22151 Moross Rd Ste 320, Maternal Fetal Medicine St John Hospital & Medical Cen, Detroit, MI 48236-2196 | 2005-09-22 |
| 1467067975 | Jerrica Clemens | Physician Assistant | 4100 Woodward Ave, Detroit, MI 48201-2173 | 2020-09-11 |
| 1679195176 | Shane Michael Dignan | Physician Assistant | 259 Mack Ave, Detroit, MI 48201-2427 | 2020-05-07 |
| 1174154843 | Weston Alexander Davis | Physician Assistant | 22101 Moross Rd, Detroit, MI 48236-2148 | 2020-01-30 |
| 1689225443 | Alaa Eddin Tahboub | Physician Assistant | 4771 Michigan Ave, Detroit, MI 48210-9718 | 2019-09-24 |
| 1609338367 | Aanchal Bhojwani | Physician Assistant | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2019-04-02 |
| 1952883068 | Jeremy Lynn Herzberg | Physician Assistant | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2018-09-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.