Provider Demographics
NPI:1790738375
Name:ESCH, LINDA (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:ESCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4071 24TH AVE
Mailing Address - Street 2:PO BOX 460
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3801
Mailing Address - Country:US
Mailing Address - Phone:810-824-4222
Mailing Address - Fax:810-824-4220
Practice Address - Street 1:558 LOCKWOOD LN
Practice Address - Street 2:
Practice Address - City:MIO
Practice Address - State:MI
Practice Address - Zip Code:48647-9387
Practice Address - Country:US
Practice Address - Phone:989-826-9271
Practice Address - Fax:989-826-7139
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704141842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4747273Medicaid
MI4704141842OtherMI LICENSE
MI4747282Medicaid
MIP09220Medicare UPIN
MI4747282Medicaid
MIP34780080Medicare UPIN