Provider Demographics
NPI:1568859734
Name:RADDER, LINDA (AGPCNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:RADDER
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-1626
Mailing Address - Country:US
Mailing Address - Phone:414-344-1746
Mailing Address - Fax:414-931-0537
Practice Address - Street 1:1821 N 16TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1626
Practice Address - Country:US
Practice Address - Phone:414-344-1746
Practice Address - Fax:414-931-0537
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6157363LA2200X
WI560106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist