Provider Demographics
NPI:1316376627
Name:PHANORD, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PHANORD
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 1:459 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6412
Mailing Address - Country:US
Mailing Address - Phone:914-654-6540
Mailing Address - Fax:914-654-4890
Practice Address - Street 1:459 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-6412
Practice Address - Country:US
Practice Address - Phone:914-654-6540
Practice Address - Fax:914-654-4890
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313661-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse