Provider Demographics
NPI:1023325859
Name:HOUSE, LINDA 'LYNN' MICHELLE (LPN)
Entity type:Individual
Prefix:MS
First Name:LINDA 'LYNN'
Middle Name:MICHELLE
Last Name:HOUSE
Suffix:
Gender:F
Credentials:LPN
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 24
Mailing Address - Street 2:
Mailing Address - City:GRAND RONDE
Mailing Address - State:OR
Mailing Address - Zip Code:97347-0024
Mailing Address - Country:US
Mailing Address - Phone:508-376-9222
Mailing Address - Fax:
Practice Address - Street 1:7650 BIRCH STREET
Practice Address - Street 2:
Practice Address - City:GRAND RONDE
Practice Address - State:OR
Practice Address - Zip Code:97347-0024
Practice Address - Country:US
Practice Address - Phone:503-376-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR084057536LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse