Provider Demographics
NPI:1376604421
Name:MCHUGH, LINDA LAEL (CPNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LAEL
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-787-6402
Mailing Address - Fax:916-787-6419
Practice Address - Street 1:1840 SIERRA GARDENS DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2912
Practice Address - Country:US
Practice Address - Phone:916-787-6402
Practice Address - Fax:916-787-6419
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN411646363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ12402Medicare UPIN