Healthcare Provider Details

I. General information

NPI: 1427059849
Provider Name (Legal Business Name): LINDA HURST FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 WEST LANE
STOCKTON CA
95210-3377
US

IV. Provider business mailing address

7272 WEST LN
STOCKTON CA
95210-3388
US

V. Phone/Fax

Practice location:
  • Phone: 209-476-3405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberN227101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: