Provider Demographics
NPI:1851060792
Name:WETMORE, LINDA ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANN
Last Name:WETMORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:ANN
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4301 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-4472
Mailing Address - Country:US
Mailing Address - Phone:580-442-4085
Mailing Address - Fax:580-442-7578
Practice Address - Street 1:3445 KOEHLER LOOP
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-6008
Practice Address - Country:US
Practice Address - Phone:580-442-4085
Practice Address - Fax:580-442-7578
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29125163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse