Provider Demographics
NPI:1003026840
Name:WELLS, LINDA SUE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:SUE
Other - Last Name:NUTALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:1808 RANCHO ENCANTADO COURT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358
Mailing Address - Country:US
Mailing Address - Phone:209-596-7477
Mailing Address - Fax:800-611-7121
Practice Address - Street 1:1808 RANCHO ENCANTADO COURT
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-7128
Practice Address - Country:US
Practice Address - Phone:209-596-7477
Practice Address - Fax:800-611-7128
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN149689251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN003980Medicare ID - Type UnspecifiedLVN PROVIDER
CAEPS011650Medicare ID - Type UnspecifiedLVN PROVIDER