Provider Demographics
NPI:1326227554
Name:RAGAB, LINDA HACK (LPN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:HACK
Last Name:RAGAB
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 N 124TH DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6597
Mailing Address - Country:US
Mailing Address - Phone:623-535-6418
Mailing Address - Fax:623-935-0058
Practice Address - Street 1:1917 N 124TH DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6597
Practice Address - Country:US
Practice Address - Phone:623-535-6418
Practice Address - Fax:623-935-0058
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPO39690164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse