Provider Demographics
NPI:1881294916
Name:PRY, LINDA MARIA X
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIA
Last Name:PRY
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 WAR EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51109-1700
Mailing Address - Country:US
Mailing Address - Phone:712-224-4308
Mailing Address - Fax:
Practice Address - Street 1:4230 WAR EAGLE DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51109-1700
Practice Address - Country:US
Practice Address - Phone:712-224-4308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA102743163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse