Healthcare Provider Details

I. General information

NPI: 1790865434
Provider Name (Legal Business Name): LINETTE JEANNA EWING D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINETTE JEANNA TIBBEN DO, MPH

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

601 CHILDRENS LN
NORFOLK VA
23507-1971
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7331
  • Fax:
Mailing address:
  • Phone: 757-668-7331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS0284
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDO.1129
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102202051
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number0102202051
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: