Provider Demographics
NPI:1730118720
Name:BEADLE, LINDA JO (NP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JO
Last Name:BEADLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2246
Mailing Address - Country:US
Mailing Address - Phone:781-784-6229
Mailing Address - Fax:
Practice Address - Street 1:200 COPELAND DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1225
Practice Address - Country:US
Practice Address - Phone:508-339-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S48673Medicare UPIN
MABE NP0875Medicare ID - Type Unspecified