Healthcare Provider Details

I. General information

NPI: 1386836468
Provider Name (Legal Business Name): LINDA ANN NELSON NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HAMILTON AVENUE CAYUGA HOME FOR CHILDREN
AUBURN NY
13021
US

IV. Provider business mailing address

101 HAMILTON AVENUE CAYUGA HOME FOR CHILDREN
AUBURN NY
13021
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-5383
  • Fax: 315-253-7278
Mailing address:
  • Phone: 315-253-5383
  • Fax: 315-253-7278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400677
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: