Provider Demographics
NPI:1205260577
Name:VANDERLINDEN, RUSSELL WL (FNP)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:WL
Last Name:VANDERLINDEN
Suffix:
Gender:M
Credentials:FNP
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 226
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-0226
Mailing Address - Country:US
Mailing Address - Phone:816-520-1710
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:1860 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-7179
Practice Address - Country:US
Practice Address - Phone:816-415-2828
Practice Address - Fax:816-883-2993
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013030774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily