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:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY417219-1163WG0000X, 163WP0200X, 163WP1700X, 163WP2201X, 163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Not Answered163WP1700XNursing Service ProvidersRegistered NursePerinatal
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Not Answered163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory