Provider Demographics
NPI:1609804061
Name:DEAN, LINDA M (ANP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:DEAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-9582
Mailing Address - Country:US
Mailing Address - Phone:215-740-7060
Mailing Address - Fax:
Practice Address - Street 1:26351 PATRIOTS WAY
Practice Address - Street 2:102 LLOYD LANE
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2575
Practice Address - Country:US
Practice Address - Phone:302-933-9442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP003309C363LA2200X
DELB-0000236363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS52337Medicare UPIN