Provider Demographics
NPI:1013050301
Name:BIRD, LINDA CELLA (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:CELLA
Last Name:BIRD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5485
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-0485
Mailing Address - Country:US
Mailing Address - Phone:503-586-8291
Mailing Address - Fax:503-689-8076
Practice Address - Street 1:780 COMMERCIAL ST SE STE 103
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3465
Practice Address - Country:US
Practice Address - Phone:503-586-8291
Practice Address - Fax:503-689-8076
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099006422RN163W00000X
OR099006422N1363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR210764Medicaid
ORS31385Medicare UPIN
OR210764Medicaid