Provider Demographics
NPI:1326069014
Name:BIDDISON, LINDA J (AP RN, BC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:J
Last Name:BIDDISON
Suffix:
Gender:F
Credentials:AP RN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9138 N TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1449
Mailing Address - Country:US
Mailing Address - Phone:309-691-7879
Mailing Address - Fax:217-872-1704
Practice Address - Street 1:2524 FARRAGUT DR # C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-8400
Practice Address - Country:US
Practice Address - Phone:217-698-3505
Practice Address - Fax:217-698-3502
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0005832068OtherBC BS GROUP
IL1326069014OtherNPI INDIVIDUAL
ILP00301784OtherINDIVIDUAL RR MEDICARE NO
IL1528084266OtherGROUP NPI
ILDE5770OtherRR MEDICARE GROUP
ILP00301784OtherINDIVIDUAL RR MEDICARE NO
IL1528084266OtherGROUP NPI
IL213056Medicare ID - Type UnspecifiedGROUP MEDICARE #