Provider Demographics
NPI:1922204254
Name:LINN, JOLEEN
Entity Type:Individual
Prefix:
First Name:JOLEEN
Middle Name:
Last Name:LINN
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:W8524 HILLVIEW RD
Mailing Address - Street 2:
Mailing Address - City:HORTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54944-9366
Mailing Address - Country:US
Mailing Address - Phone:480-882-8865
Mailing Address - Fax:
Practice Address - Street 1:W8524 HILLVIEW RD
Practice Address - Street 2:
Practice Address - City:HORTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54944-9366
Practice Address - Country:US
Practice Address - Phone:480-882-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-24
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2767314000000X
WI5490-26314000000X
IA077176314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility