Provider Demographics
NPI:1841801040
Name:STIDHAM, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:STIDHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:FRIENDSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45630-0248
Mailing Address - Country:US
Mailing Address - Phone:740-961-2315
Mailing Address - Fax:
Practice Address - Street 1:147 VAUGHTERS RUN RD
Practice Address - Street 2:
Practice Address - City:WEST PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663-9200
Practice Address - Country:US
Practice Address - Phone:740-858-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide