Provider Demographics
NPI:1770030033
Name:STUBBLEFIELD, LINDA MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARIE
Last Name:STUBBLEFIELD
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 1:17750 BERTA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:PRUNEDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93907-1394
Mailing Address - Country:US
Mailing Address - Phone:831-214-2156
Mailing Address - Fax:
Practice Address - Street 1:17750 BERTA CANYON RD
Practice Address - Street 2:
Practice Address - City:PRUNEDALE
Practice Address - State:CA
Practice Address - Zip Code:93907-1394
Practice Address - Country:US
Practice Address - Phone:831-214-2156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-04
Last Update Date:2016-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345667163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse