Healthcare Provider Details

I. General information

NPI: 1386230761
Provider Name (Legal Business Name): LINDA R STOLLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 CAROL LN
PERRYSBURG OH
43551-2967
US

IV. Provider business mailing address

540 CAROL LN
PERRYSBURG OH
43551-2967
US

V. Phone/Fax

Practice location:
  • Phone: 419-872-0714
  • Fax:
Mailing address:
  • Phone: 419-872-0714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberRR779313
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: