Provider Demographics
NPI:1356547343
Name:DENNISON, LINDA SUE
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUE
Last Name:DENNISON
Suffix:
Gender:F
Credentials:
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 2558
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-2558
Mailing Address - Country:US
Mailing Address - Phone:928-283-2458
Mailing Address - Fax:
Practice Address - Street 1:167 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-0600
Practice Address - Country:US
Practice Address - Phone:928-283-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY417219-1163WG0000X, 163WP0200X, 163WP1700X, 163WP2201X, 163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory