Provider Demographics
NPI:1376332155
Name:LINDER, MANDELA
Entity type:Individual
Prefix:
First Name:MANDELA
Middle Name:
Last Name:LINDER
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 1:935 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-3838
Mailing Address - Country:US
Mailing Address - Phone:707-472-7937
Mailing Address - Fax:
Practice Address - Street 1:327 E REDWOOD AVE STE D
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-3550
Practice Address - Country:US
Practice Address - Phone:707-472-7937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula