Provider Demographics
NPI:1033478417
Name:LINDEN, GERALD (LPN)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:LINDEN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 STATE ROUTE 58
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:OH
Mailing Address - Zip Code:44880-9762
Mailing Address - Country:US
Mailing Address - Phone:440-225-7068
Mailing Address - Fax:
Practice Address - Street 1:262 STATE ROUTE 58
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:OH
Practice Address - Zip Code:44880-9762
Practice Address - Country:US
Practice Address - Phone:440-225-7068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147828164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse