Provider Demographics
NPI:1568665651
Name:MACY, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MACY
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 1:470 CLEARVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:MT
Mailing Address - Zip Code:59828
Mailing Address - Country:US
Mailing Address - Phone:406-961-5468
Mailing Address - Fax:
Practice Address - Street 1:470 CLEARVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:MT
Practice Address - Zip Code:59828
Practice Address - Country:US
Practice Address - Phone:406-961-5468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0840294OtherPROVIDER NUMBER