Provider Demographics
NPI:1427214782
Name:WICKLAND, LINDA (LPN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WICKLAND
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 1:5808 E BROWN RD APT 37
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4440
Mailing Address - Country:US
Mailing Address - Phone:480-993-6316
Mailing Address - Fax:
Practice Address - Street 1:5808 E BROWN RD APT 37
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4440
Practice Address - Country:US
Practice Address - Phone:480-993-6316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP027889164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse