Healthcare Provider Details

I. General information

NPI: 1588768840
Provider Name (Legal Business Name): LINDA L LINDEKE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVENUE SOUTH CHILDRENS HOSPITALS AND CLINICS EMERGENCY PHYSICIANS MP
MINNEAPOLIS MN
55404
US

IV. Provider business mailing address

2910 CENTRE POINTE DRIVE 35 121A
ROSEVILLE MN
55113
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6111
  • Fax:
Mailing address:
  • Phone: 651-855-2109
  • Fax: 651-855-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0824901
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR0824901
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR0824901
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: