Healthcare Provider Details

I. General information

NPI: 1891923454
Provider Name (Legal Business Name): LINDA ANN CARTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 SE SUNNYSIDE RD
CLACKAMAS OR
97015-9750
US

IV. Provider business mailing address

30021 SODAVILLE MTN HOME RD
LEBANON OR
97355-9005
US

V. Phone/Fax

Practice location:
  • Phone: 503-904-7811
  • Fax:
Mailing address:
  • Phone: 503-551-8349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200242629RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: