Healthcare Provider Details

I. General information

NPI: 1356547343
Provider Name (Legal Business Name): MS. LINDA SUE DENNISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 NORTH MAIN STREET
TUBA CITY AZ
86045-0600
US

IV. Provider business mailing address

PO BOX 2558
TUBA CITY AZ
86045-2558
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-2501
  • Fax:
Mailing address:
  • Phone: 928-283-2458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number417219-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number417219-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number417219-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number417219-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number417219-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: