Provider Demographics
NPI:1841287653
Name:HERSEY, LINDA CAROL (NP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:CAROL
Last Name:HERSEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4301
Mailing Address - Country:US
Mailing Address - Phone:301-932-9029
Mailing Address - Fax:
Practice Address - Street 1:23140 MOAKLEY ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2930
Practice Address - Country:US
Practice Address - Phone:301-997-1029
Practice Address - Fax:301-997-1489
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR038903363LA2200X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS64447Medicare ID - Type Unspecified