Provider Demographics
NPI:1669519724
Name:DEMAS, LINDA NOLL (MSN, APRN)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:NOLL
Last Name:DEMAS
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:NOLL
Other - Last Name:DEMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, APRN
Mailing Address - Street 1:8 RIDGE DR SO
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4227
Mailing Address - Country:US
Mailing Address - Phone:860-388-3166
Mailing Address - Fax:860-388-3167
Practice Address - Street 1:8 RIDGE DR
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4227
Practice Address - Country:US
Practice Address - Phone:860-388-3166
Practice Address - Fax:860-388-3167
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000778364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health