Provider Demographics
NPI:1619178209
Name:LINDEN, GERALDINE ILENE (LPN)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:ILENE
Last Name:LINDEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 DE KOVEN AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-2404
Mailing Address - Country:US
Mailing Address - Phone:262-637-8841
Mailing Address - Fax:
Practice Address - Street 1:3107 67TH DR
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-9445
Practice Address - Country:US
Practice Address - Phone:262-878-3727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32387-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI164W00000XMedicaid