Healthcare Provider Details

I. General information

NPI: 1164572590
Provider Name (Legal Business Name): LINDA MARIE PEDERSEN MNARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WINSLOW WAY E STE 114
BAINBRIDGE ISLAND WA
98110-3252
US

IV. Provider business mailing address

600 WINSLOW WAY E STE 114
BAINBRIDGE ISLAND WA
98110-3252
US

V. Phone/Fax

Practice location:
  • Phone: 206-842-5979
  • Fax: 306-842-4124
Mailing address:
  • Phone: 206-842-5979
  • Fax: 206-842-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30004070
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: