Provider Demographics
NPI:1720008048
Name:LEPOER, LINDA (RN, MS, CNS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LEPOER
Suffix:
Gender:F
Credentials:RN, MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1903
Mailing Address - Country:US
Mailing Address - Phone:508-754-1803
Mailing Address - Fax:508-792-9713
Practice Address - Street 1:130 ELM ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1903
Practice Address - Country:US
Practice Address - Phone:508-754-1803
Practice Address - Fax:508-792-9713
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187592364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0044Medicare ID - Type Unspecified