Provider Demographics
NPI:1538296330
Name:CROMWELL, LINDA D (BSN, RN, PHN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:D
Last Name:CROMWELL
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Gender:F
Credentials:BSN, RN, PHN
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Mailing Address - Street 1:2031 NEZ PERCE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-5358
Mailing Address - Country:US
Mailing Address - Phone:530-543-6867
Mailing Address - Fax:530-541-2803
Practice Address - Street 1:981 SILVER DOLLAR AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7761
Practice Address - Country:US
Practice Address - Phone:530-573-3274
Practice Address - Fax:530-541-2803
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA385076364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health