Provider Demographics
NPI:1437641701
Name:MCNICHOL, LINDA PORTER
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:PORTER
Last Name:MCNICHOL
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 1:15 ASHLEY CT
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-2006
Mailing Address - Country:US
Mailing Address - Phone:610-558-4473
Mailing Address - Fax:
Practice Address - Street 1:100 YEARSLEY MILL RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5518
Practice Address - Country:US
Practice Address - Phone:484-227-1400
Practice Address - Fax:484-227-1497
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN509036L163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)