Provider Demographics
NPI:1760911671
Name:DEWHITT, LINDA (LPN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:DEWHITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:RIEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2981 SE 21ST ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-9249
Mailing Address - Country:US
Mailing Address - Phone:503-830-5508
Mailing Address - Fax:
Practice Address - Street 1:2981 SE 21ST ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-9249
Practice Address - Country:US
Practice Address - Phone:503-830-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200930374LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse