Healthcare Provider Details

I. General information

NPI: 1013050301
Provider Name (Legal Business Name): LINDA CELLA BIRD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 COMMERCIAL ST SE STE 103
SALEM OR
97301-3465
US

IV. Provider business mailing address

PO BOX 5485
SALEM OR
97304-0485
US

V. Phone/Fax

Practice location:
  • Phone: 503-586-8291
  • Fax: 503-689-8076
Mailing address:
  • Phone: 503-586-8291
  • Fax: 503-689-8076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number099006422RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number099006422N1
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: