Provider Demographics
NPI:1831199330
Name:REDMON, LINDA (MS, CN, LMP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:REDMON
Suffix:
Gender:F
Credentials:MS, CN, LMP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2526
Mailing Address - Country:US
Mailing Address - Phone:360-568-3319
Mailing Address - Fax:360-568-5106
Practice Address - Street 1:302 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2526
Practice Address - Country:US
Practice Address - Phone:360-568-3319
Practice Address - Fax:360-568-5106
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU00001735133N00000X
WAMA00014587225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist