Healthcare Provider Details

I. General information

NPI: 1023242674
Provider Name (Legal Business Name): LINDA LINDBERG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 W WARNER RD
GILBERT AZ
85233-7266
US

IV. Provider business mailing address

280 1ST ST
HOLLOMAN AFB NM
88330-8273
US

V. Phone/Fax

Practice location:
  • Phone: 480-722-9828
  • Fax: 480-722-9831
Mailing address:
  • Phone: 575-572-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3168
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: