Provider Demographics
NPI:1497881585
Name:CALDWELL, LINDA S
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:S
Last Name:CALDWELL
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 1:2923 HARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2039
Mailing Address - Country:US
Mailing Address - Phone:937-294-3340
Mailing Address - Fax:
Practice Address - Street 1:6221 HEMPSTEAD MEWS
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-1511
Practice Address - Country:US
Practice Address - Phone:937-439-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2419716Medicaid