Provider Demographics
NPI:1417506148
Name:TOTTINGHAM, LINDA RAE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:RAE
Last Name:TOTTINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 RIVER PARK ROAD SE
Mailing Address - Street 2:
Mailing Address - City:ORONOCO
Mailing Address - State:MN
Mailing Address - Zip Code:55960
Mailing Address - Country:US
Mailing Address - Phone:507-273-9142
Mailing Address - Fax:
Practice Address - Street 1:471 RIVER PARK ROAD SE
Practice Address - Street 2:
Practice Address - City:ORONOCO
Practice Address - State:MN
Practice Address - Zip Code:55960
Practice Address - Country:US
Practice Address - Phone:507-273-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider