Provider Demographics
NPI:1912182080
Name:TERRIBILE, LINDA A (LPN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:TERRIBILE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WASHINGTON ROAD
Mailing Address - Street 2:KELLER ARMY COMMUNITY HOSPITAL
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996
Mailing Address - Country:US
Mailing Address - Phone:845-938-8476
Mailing Address - Fax:845-938-6154
Practice Address - Street 1:900 WASHINGTON ROAD
Practice Address - Street 2:KELLER ARMY COMMUNITY HOSPITAL
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996
Practice Address - Country:US
Practice Address - Phone:845-938-8476
Practice Address - Fax:845-938-6154
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239554164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVAD000Medicare UPIN