Provider Demographics
NPI:1942437785
Name:DRIES, LINDA J (MS, APRN, BC-ADM)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:J
Last Name:DRIES
Suffix:
Gender:F
Credentials:MS, APRN, BC-ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 E STATE ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-2333
Mailing Address - Country:US
Mailing Address - Phone:815-489-4396
Mailing Address - Fax:815-967-5404
Practice Address - Street 1:1415 E STATE ST
Practice Address - Street 2:SUITE 700
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2333
Practice Address - Country:US
Practice Address - Phone:815-489-4396
Practice Address - Fax:815-967-5404
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.145507364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist