Provider Demographics
NPI:1437284676
Name:MCDERMOTT, LINDA MAE (RN057451)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MAE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:RN057451
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2848 E CHOLLA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1935
Mailing Address - Country:US
Mailing Address - Phone:602-867-3988
Mailing Address - Fax:602-229-8378
Practice Address - Street 1:4525 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1816
Practice Address - Country:US
Practice Address - Phone:602-764-7511
Practice Address - Fax:602-229-8378
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 057451163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ583171Medicaid