Provider Demographics
NPI:1629000443
Name:HERMAN, LINDA A (CRNA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:HERMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:A
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3460 RIVERKNOLL WAY
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3625
Mailing Address - Country:US
Mailing Address - Phone:503-650-4955
Mailing Address - Fax:
Practice Address - Street 1:9205 SW BARNES RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6603
Practice Address - Country:US
Practice Address - Phone:503-216-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00149343163W00000X
WAAP30006464367500000X
MI4704102238367500000X
TX627724367500000X
OR367500000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0200429OtherLABOR & IND
WA9639881Medicaid
OR268765Medicaid
P25144Medicare UPIN
WA9639881Medicaid