Provider Demographics
NPI:1700447455
Name:MYERS, LINDA D
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:MYERS
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 1:4224 HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:81527-9421
Mailing Address - Country:US
Mailing Address - Phone:970-270-4456
Mailing Address - Fax:
Practice Address - Street 1:1050 WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8121
Practice Address - Country:US
Practice Address - Phone:970-298-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994864-NP363LP2300X
CO0108436163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse