Provider Demographics
NPI:1467554501
Name:GROSSMAN, LINDA L (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 BURNS WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3110
Mailing Address - Country:US
Mailing Address - Phone:406-755-5266
Mailing Address - Fax:406-755-0228
Practice Address - Street 1:1280 BURNS WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3110
Practice Address - Country:US
Practice Address - Phone:406-755-5266
Practice Address - Fax:406-755-0228
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN19621363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0431137Medicaid
MT0431137Medicaid
MTS51011Medicare UPIN