Provider Demographics
NPI:1497404453
Name:FETTERMAN, LINDA ALICE (RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ALICE
Last Name:FETTERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 PHILMAY TER
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2220
Mailing Address - Country:US
Mailing Address - Phone:484-792-1390
Mailing Address - Fax:
Practice Address - Street 1:2700 PHILMAY TER
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2220
Practice Address - Country:US
Practice Address - Phone:484-792-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN194577L163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management