Provider Demographics
NPI:1831751494
Name:PETERSON, LINNEA DENISE (CNA)
Entity type:Individual
Prefix:
First Name:LINNEA
Middle Name:DENISE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 POWELL CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-4172
Mailing Address - Country:US
Mailing Address - Phone:239-440-4856
Mailing Address - Fax:
Practice Address - Street 1:116 POWELL CREEK CIR
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-4172
Practice Address - Country:US
Practice Address - Phone:239-440-4856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
126586376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide