Provider Demographics
NPI:1417994732
Name:WELLINGTON, LINDA M (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:M
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:M
Other - Last Name:NUZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:7095S PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9794
Mailing Address - Country:US
Mailing Address - Phone:330-360-0690
Mailing Address - Fax:
Practice Address - Street 1:740 E STATE ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3328
Practice Address - Country:US
Practice Address - Phone:724-983-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.128916367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00761210OtherMEDICARE RAILROAD
PA082627ZB29OtherMEDICARE PTAN
OH000000602887OtherANTHEM BCBS
OH0764472Medicaid