Provider Demographics
NPI:1356987739
Name:TRADER, LINDA JEAN
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:TRADER
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 1:12180 PARK AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98447-0014
Mailing Address - Country:US
Mailing Address - Phone:253-535-7672
Mailing Address - Fax:253-535-7590
Practice Address - Street 1:12180 PARK AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98447-0014
Practice Address - Country:US
Practice Address - Phone:253-535-7672
Practice Address - Fax:253-535-7590
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAAP61322871363LP0808X
WARN60905611163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WE0003XNursing Service ProvidersRegistered NurseEmergency