Healthcare Provider Details

I. General information

NPI: 1588926158
Provider Name (Legal Business Name): LINDA T TURNBULL EZEDONMWEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BALLOU AVE APT 1
BOSTON MA
02124-4105
US

IV. Provider business mailing address

1 BALLOU AVE APT 1
BOSTON MA
02124-4105
US

V. Phone/Fax

Practice location:
  • Phone: 617-905-7390
  • Fax:
Mailing address:
  • Phone: 617-905-7390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number212112
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number212112
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: