Healthcare Provider Details

I. General information

NPI: 1992611263
Provider Name (Legal Business Name): SONJA LINDE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 BRISTOL LN
NEW LENOX IL
60451-9227
US

IV. Provider business mailing address

832 BRISTOL LN
NEW LENOX IL
60451-9227
US

V. Phone/Fax

Practice location:
  • Phone: 757-704-1000
  • Fax: 757-271-6649
Mailing address:
  • Phone: 757-704-1000
  • Fax: 757-271-6649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041307819
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: