Provider Demographics
NPI:1407844699
Name:MCFADDEN, LINDA ROSANN (CRNA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ROSANN
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4346
Mailing Address - Street 2:DEPT 398
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4346
Mailing Address - Country:US
Mailing Address - Phone:281-358-8114
Mailing Address - Fax:281-358-0609
Practice Address - Street 1:4120 SOUTHWEST FWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7339
Practice Address - Country:US
Practice Address - Phone:713-626-8500
Practice Address - Fax:713-626-8560
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX659608367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84094UOtherBCBS ROAC
TX86928UOtherBCBS TAC HOUSTON
TX050209OtherRECERTIFICATION AANA
TXP00158838OtherRAILROAD MEDICARE
TXP00402665OtherRR MCR TAC HOUSTON
TX8D5554Medicare ID - Type UnspecifiedTAC HOUSTON
TX84094UOtherBCBS ROAC
TX050209OtherRECERTIFICATION AANA