Provider Demographics
NPI:1205022787
Name:CASSIDY, LINDA C
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:CASSIDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:101 LAUREL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222
Mailing Address - Country:US
Mailing Address - Phone:520-836-8500
Mailing Address - Fax:
Practice Address - Street 1:2730 NORTH TREKELL ROAD
Practice Address - Street 2:CASA GRANDE UNION HIGH SCHOOL
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222
Practice Address - Country:US
Practice Address - Phone:520-836-8500
Practice Address - Fax:850-316-3353
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN091103163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse