Provider Demographics
NPI:1598362634
Name:BANDA, LINDA JO
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JO
Last Name:BANDA
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:PO BOX 3438
Mailing Address - Street 2:
Mailing Address - City:MORIARTY
Mailing Address - State:NM
Mailing Address - Zip Code:87035-3438
Mailing Address - Country:US
Mailing Address - Phone:505-440-9329
Mailing Address - Fax:
Practice Address - Street 1:3347 E MARTINEZ RD
Practice Address - Street 2:
Practice Address - City:MORIARTY
Practice Address - State:NM
Practice Address - Zip Code:87035-8151
Practice Address - Country:US
Practice Address - Phone:505-440-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider