Provider Demographics
NPI:1609865013
Name:ODANIEL, LINDA R (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:ODANIEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 CHAMBERLAIN LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-1603
Mailing Address - Country:US
Mailing Address - Phone:502-243-9044
Mailing Address - Fax:502-243-8482
Practice Address - Street 1:2701 CHAMBERLAIN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-1603
Practice Address - Country:US
Practice Address - Phone:502-243-9044
Practice Address - Fax:502-243-8482
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3299P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
0680404Medicare ID - Type Unspecified
Q03723Medicare UPIN