Provider Demographics
NPI:1720084676
Name:DAHL, LINDA SUSAN (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:DAHL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:SUSAN
Other - Last Name:STARCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:923 GEORGIANA STREET
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362
Mailing Address - Country:US
Mailing Address - Phone:360-912-2495
Mailing Address - Fax:
Practice Address - Street 1:923 GEORGIANA ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3911
Practice Address - Country:US
Practice Address - Phone:360-912-2495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004712363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30004712OtherARNP
WAAP30004712OtherARNP