Healthcare Provider Details

I. General information

NPI: 1710301510
Provider Name (Legal Business Name): DANA LINEHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 SELKIRK CIR
GARDNERVILLE NV
89460-8887
US

IV. Provider business mailing address

870 SELKIRK CIR
GARDNERVILLE NV
89460-8887
US

V. Phone/Fax

Practice location:
  • Phone: 775-450-7352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: