Healthcare Provider Details

I. General information

NPI: 1376866673
Provider Name (Legal Business Name): STEPHEN JEFFREY LINCK RN, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 411, BLDG 700, ROSE BARRACKS USA MEDDAC BAVARIA
APO AE
09112
US

IV. Provider business mailing address

CMR 411, BLDG 700, ROSE BARRACKS USA MEDDAC BAVARIA
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 499662834719
  • Fax: 499662834721
Mailing address:
  • Phone: 499662834719
  • Fax: 499662834721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number073221
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number649473
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: