Provider Demographics
NPI:1972172922
Name:LINDA DEMANOU
Entity Type:Organization
Organization Name:LINDA DEMANOU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMANOU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-701-6437
Mailing Address - Street 1:9375 CHISHOLM TRL
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0411
Mailing Address - Country:US
Mailing Address - Phone:903-521-0385
Mailing Address - Fax:888-960-2797
Practice Address - Street 1:4293 KINSEY DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1004
Practice Address - Country:US
Practice Address - Phone:903-592-5670
Practice Address - Fax:888-960-2797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOICE SUPPORTIVE CARE TEAM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP145557OtherSTATE LICENSE