Provider Demographics
NPI:1942510094
Name:LEE, LINDA SUE (BSN JD MSN FNP-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:LEE
Suffix:
Gender:F
Credentials:BSN JD MSN FNP-C
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:ALRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:615 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1033
Practice Address - Country:US
Practice Address - Phone:574-647-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28070584A363LF0000X
IN71003570A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000712068OtherBCBS BEACON HEALTH SYSTEM
IN201021500Medicaid
IN000000712068OtherBCBS BEACON HEALTH SYSTEM