Provider Demographics
NPI:1356577431
Name:DAVIS, LINDA SUE (RN, GCNS-BC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, GCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 PICO DR
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-4727
Mailing Address - Country:US
Mailing Address - Phone:540-320-1534
Mailing Address - Fax:
Practice Address - Street 1:330 PICO DR
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-4727
Practice Address - Country:US
Practice Address - Phone:540-320-1534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000868364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist