Healthcare Provider Details

I. General information

NPI: 1033478417
Provider Name (Legal Business Name): GERALD LINDEN LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 STATE ROUTE 58
SULLIVAN OH
44880-9762
US

IV. Provider business mailing address

262 STATE ROUTE 58
SULLIVAN OH
44880-9762
US

V. Phone/Fax

Practice location:
  • Phone: 440-225-7068
  • Fax:
Mailing address:
  • Phone: 440-225-7068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number147828
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: