Provider Demographics
NPI:1013235803
Name:MULDER, LINDA KATHERINE (PA)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:KATHERINE
Last Name:MULDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:WI
Mailing Address - Zip Code:53956-1499
Mailing Address - Country:US
Mailing Address - Phone:920-326-5060
Mailing Address - Fax:
Practice Address - Street 1:504 S HIGH ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:WI
Practice Address - Zip Code:53956-1499
Practice Address - Country:US
Practice Address - Phone:920-326-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant