Provider Demographics
NPI:1003826447
Name:ROHAN, LINDA JONES (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JONES
Last Name:ROHAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 114TH AVE SE
Mailing Address - Street 2:102
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6942
Mailing Address - Country:US
Mailing Address - Phone:206-310-0096
Mailing Address - Fax:425-454-2315
Practice Address - Street 1:1300 114TH AVE SE
Practice Address - Street 2:102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6942
Practice Address - Country:US
Practice Address - Phone:206-310-0096
Practice Address - Fax:425-454-2315
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002295364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92204546Medicaid
Q61843Medicare UPIN