Provider Demographics
NPI:1134171762
Name:MCCLINTOCK, LINDA LOU (ARNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LOU
Last Name:MCCLINTOCK
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 1:217 CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-2522
Mailing Address - Country:US
Mailing Address - Phone:712-732-0194
Mailing Address - Fax:712-213-0186
Practice Address - Street 1:630 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-1845
Practice Address - Country:US
Practice Address - Phone:712-213-0109
Practice Address - Fax:712-213-0186
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA088620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15484OtherWELLMARK
IAR03122Medicare UPIN
IA15484OtherWELLMARK