Healthcare Provider Details

I. General information

NPI: 1407809668
Provider Name (Legal Business Name): LINDA M TOWLE MSN, GNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MONTGOMERY DR STE 222
SANTA ROSA CA
95404-6629
US

IV. Provider business mailing address

95 MONTGOMERY DR STE 222
SANTA ROSA CA
95404-6629
US

V. Phone/Fax

Practice location:
  • Phone: 707-579-1968
  • Fax: 707-542-1970
Mailing address:
  • Phone: 901-273-2368
  • Fax: 901-273-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP10951
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP10951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: