Provider Demographics
NPI:1164745113
Name:CLARKE, LINDA W (RN BSN MED NCSN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:W
Last Name:CLARKE
Suffix:
Gender:F
Credentials:RN BSN MED NCSN
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Mailing Address - Street 1:7406 S OGLESBY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3312
Mailing Address - Country:US
Mailing Address - Phone:773-768-1117
Mailing Address - Fax:773-933-6994
Practice Address - Street 1:7406 S OGLESBY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3312
Practice Address - Country:US
Practice Address - Phone:773-768-1117
Practice Address - Fax:773-933-6994
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL041.195463133NN1002X, 163WA2000X, 163WC0400X, 163WC1600X, 163WG0000X, 163WN1003X, 163WP0200X, 364SC1501X, 364SS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
No364SS0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistSchool