Provider Demographics
NPI:1326094186
Name:PELLAND, LINDA L (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:PELLAND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 FAUNTLEROY WAY SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:360-825-6536
Practice Address - Street 1:4550 FAUNTLEROY WAY SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3471
Practice Address - Country:US
Practice Address - Phone:425-888-5511
Practice Address - Fax:360-825-6536
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005870207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1007771Medicaid
WA9637026Medicaid
WAP87223Medicare UPIN