Provider Demographics
NPI:1700332574
Name:HIXSON, LINDA M (LMT,LE)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:HIXSON
Suffix:
Gender:F
Credentials:LMT,LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 N WHITETAIL RD
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-8305
Mailing Address - Country:US
Mailing Address - Phone:520-339-9707
Mailing Address - Fax:
Practice Address - Street 1:2122 N CRAYCROFT RD SUITE 12
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2849
Practice Address - Country:US
Practice Address - Phone:520-339-9707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-14224174400000X
AZ31100070174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist