Provider Demographics
NPI:1659501310
Name:VEENHUIS WEBB, LINDA D (RN BSCN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:VEENHUIS WEBB
Suffix:
Gender:F
Credentials:RN BSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WINCHESTER DR
Mailing Address - Street 2:STANSBURY PARK
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-8212
Mailing Address - Country:US
Mailing Address - Phone:618-520-4042
Mailing Address - Fax:
Practice Address - Street 1:443 S 600 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2708
Practice Address - Country:US
Practice Address - Phone:801-538-2057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7343560-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTRN 7343560-3102Medicaid