Provider Demographics
NPI:1164572590
Name:PEDERSEN, LINDA MARIE (MNARNP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARIE
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:MNARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WINSLOW WAY E STE 114
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3252
Mailing Address - Country:US
Mailing Address - Phone:206-842-5979
Mailing Address - Fax:206-842-4124
Practice Address - Street 1:600 WINSLOW WAY E STE 114
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3252
Practice Address - Country:US
Practice Address - Phone:206-842-5979
Practice Address - Fax:306-842-4124
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAP30004070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9649500Medicaid
WA9649500Medicaid
WAS20105Medicare UPIN