Provider Demographics
NPI:1093132219
Name:DURDEN, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:DURDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 WATSON BLVD STE 525
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8556
Mailing Address - Country:US
Mailing Address - Phone:478-953-4563
Mailing Address - Fax:478-953-4564
Practice Address - Street 1:3051 WATSON BLVD STE 525
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8556
Practice Address - Country:US
Practice Address - Phone:478-953-4563
Practice Address - Fax:478-953-4564
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213380363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily