Healthcare Provider Details

I. General information

NPI: 1194709147
Provider Name (Legal Business Name): LINDA A MARDEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S AVENUE A
YUMA AZ
85364-7127
US

IV. Provider business mailing address

2222 S 16TH ST STE 400A
LINCOLN NE
68502-3785
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-2000
  • Fax: 928-336-7520
Mailing address:
  • Phone: 402-483-8590
  • Fax: 402-483-8575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number44762
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number30759
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number30171
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: