Provider Demographics
NPI:1669642310
Name:MOTHERWELL, LINDA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:MOTHERWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4814
Mailing Address - Country:US
Mailing Address - Phone:936-552-1609
Mailing Address - Fax:
Practice Address - Street 1:418 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4814
Practice Address - Country:US
Practice Address - Phone:936-552-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX534217163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457899Medicare Oscar/Certification