MEDICARE: LINDA MARIE CROOKS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1500X	Community Health Registered Nurse	J244471	CA

General Provider Information

NPI Number	:	1528629995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA MARIE CROOKS RN

Provider Business Mailing Address
First Line	:	PO BOX 20952
Second Line	:
City	:	EL SOBRANTE
State	:	CA
Zip	:	94820-0952
Country	:	US
Telephone Number	:	510-210-7845
Fax Number	:

Provider Business Practice Location Address
First Line	:	4605 ELMWOOD RD
Second Line	:
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-3112
Country	:	US
Telephone Number	:	510-210-7845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	06/25/2019

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