Healthcare Provider Details

I. General information

NPI: 1285780296
Provider Name (Legal Business Name): LINDA JENNIFER GEVERTS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA GEVERTS SCOTT NP

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 PRECISSI LN
STOCKTON CA
95207-6239
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 209-477-4103
  • Fax: 209-477-1065
Mailing address:
  • Phone: 408-795-3619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: