Provider Demographics
NPI:1891785309
Name:DAVIDSON, LINDA (RN-CNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:RN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S STANFIELD RD
Mailing Address - Street 2:STE. A
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2372
Mailing Address - Country:US
Mailing Address - Phone:937-339-5355
Mailing Address - Fax:937-339-3056
Practice Address - Street 1:700 S STANFIELD RD
Practice Address - Street 2:STE. A
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2372
Practice Address - Country:US
Practice Address - Phone:937-339-5355
Practice Address - Fax:937-339-3056
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN143805163WG0000X
OHRN-143805363LA2200X
OHAPRN.CNP.01665363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2366792Medicaid
OH2366792Medicaid
OHDANP01633Medicare UPIN