Provider Demographics
NPI:1477505030
Name:PAUL, LINDA MAE (LPN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MAE
Last Name:PAUL
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 1:1004 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-1543
Mailing Address - Country:US
Mailing Address - Phone:608-295-6397
Mailing Address - Fax:
Practice Address - Street 1:10621 S HICKORY CT
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-9703
Practice Address - Country:US
Practice Address - Phone:608-368-0328
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29826-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse