Healthcare Provider Details

I. General information

NPI: 1467541011
Provider Name (Legal Business Name): LINDA LAND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W HERNDON AVENUE
CLOVIS CA
93612
US

IV. Provider business mailing address

PO BOX 11259
WESTMINSTER CA
92685-1259
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-6200
  • Fax: 559-324-6280
Mailing address:
  • Phone: 866-675-9441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP5461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: