Provider Demographics
NPI:1679006910
Name:MCDONOUGH, LINDA JOY (RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JOY
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JOY
Other - Last Name:BADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1071 RIDDLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-6980
Mailing Address - Country:US
Mailing Address - Phone:303-587-5025
Mailing Address - Fax:
Practice Address - Street 1:10240 PARK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5425
Practice Address - Country:US
Practice Address - Phone:303-338-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0169414163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse