Healthcare Provider Details

I. General information

NPI: 1720429145
Provider Name (Legal Business Name): EVA LINDEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2013
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 VT RTE 107
BETHEL VT
05032-9107
US

IV. Provider business mailing address

1823 VT RTE 107
BETHEL VT
05032-9107
US

V. Phone/Fax

Practice location:
  • Phone: 802-234-9913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33 338593
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0103365
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6579981
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0260091569
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number111696
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: