Provider Demographics
NPI:1285036871
Name:CUSTOM NURSE DELEGATION, LLC
Entity Type:Organization
Organization Name:CUSTOM NURSE DELEGATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE DELEGATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:509-724-7103
Mailing Address - Street 1:9517 N DOVER RD
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-9716
Mailing Address - Country:US
Mailing Address - Phone:509-724-7103
Mailing Address - Fax:
Practice Address - Street 1:9517 N DOVER RD
Practice Address - Street 2:
Practice Address - City:NINE MILE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99026-9716
Practice Address - Country:US
Practice Address - Phone:509-724-7103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00080653163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty