Provider Demographics
NPI:1447221221
Name:CHURCHWELL, LINDA (APN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CHURCHWELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-750-3425
Mailing Address - Fax:702-750-3434
Practice Address - Street 1:8680 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7458
Practice Address - Country:US
Practice Address - Phone:702-750-3425
Practice Address - Fax:702-750-3434
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000816363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504952Medicaid
NV100505654Medicaid
NV100505654Medicaid
P34735Medicare UPIN
NVFR916ZMedicare PIN