Healthcare Provider Details

I. General information

NPI: 1295057255
Provider Name (Legal Business Name): LINDA D. MCCORMICK R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W. TUNNELL
SANTA MARIA CA
93454
US

IV. Provider business mailing address

117 W. TUNNELL
SANTA MARIA CA
93454
US

V. Phone/Fax

Practice location:
  • Phone: 805-614-4940
  • Fax: 805-614-0179
Mailing address:
  • Phone: 805-614-4940
  • Fax: 805-614-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number520915
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number520915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: