Provider Demographics
NPI:1669648713
Name:LAYTON, LINDA J (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:LAYTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:201 RIDGE ST
Mailing Address - Street 2:#307
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4643
Mailing Address - Country:US
Mailing Address - Phone:712-329-5700
Mailing Address - Fax:712-329-5759
Practice Address - Street 1:201 RIDGE ST
Practice Address - Street 2:#307
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-329-5700
Practice Address - Fax:712-329-5759
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA001093363A00000X
NE851363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant