Provider Demographics
NPI:1295108330
Name:SUDERMAN, LINDA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SUDERMAN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-7211
Mailing Address - Country:US
Mailing Address - Phone:580-548-1347
Mailing Address - Fax:580-548-1496
Practice Address - Street 1:600 S MONROE ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7211
Practice Address - Country:US
Practice Address - Phone:580-548-1347
Practice Address - Fax:580-548-1496
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL-61366163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant