Provider Demographics
NPI:1568763035
Name:MEDERO, LINDA (RN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:MEDERO
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 1:36826 HONEY SIGN DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-9630
Mailing Address - Country:US
Mailing Address - Phone:541-258-7045
Mailing Address - Fax:
Practice Address - Street 1:36826 HONEY SIGN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-9630
Practice Address - Country:US
Practice Address - Phone:541-258-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200242176RN163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse