Healthcare Provider Details

I. General information

NPI: 1770098667
Provider Name (Legal Business Name): LINDA DUSTE RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DOYLE PARK DR STE 100
SANTA ROSA CA
95405-4559
US

IV. Provider business mailing address

500 DOYLE PARK DR STE 100
SANTA ROSA CA
95405-4559
US

V. Phone/Fax

Practice location:
  • Phone: 707-544-6090
  • Fax: 707-544-2389
Mailing address:
  • Phone: 707-544-6090
  • Fax: 707-544-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number277252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: